The URL can be used to link to this page

Home My WebLink AboutMINUTES - 08052008 - C.23 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: AUGUST 05 , 2008 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to California Government Codes. ' you is your notice of the action taken D X�S?f� � on your claim by the Board of LSCS Supervisors. (Paragraph IV below), JUL 0 3 2008 given Pursuant to Government Code AMOUNT: $500,000.00 Section 913 and 915.4. Please note all COUNTYCOUNSEL "Warnings". CLAIMANT: ANGELA MARIE DEC TpIN�2CALIF. ATTORNEY: UNKNOWN DATE RECEIVED: JULY 03, 2008 ADDRESS: 285 KATHLEEN DRIVE BY DELIVERY TO CLERK ON: JULY 031, 2008 PLEASANT HILL, CA 94523 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. JULY 03, 2408 JOHN CULLEN, C1 Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup •visors ( VI/This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are ib notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clen•k should return claim on gn•ound that it was filed late and send warning of claimant's right to apply fon- leave to present a late claim (Section 911.3). ( ) Other: Dated: —7 4 —0 `y By: Deputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV.,B'OARD ORDER: By unanimous vote of the Supervisors present: (vJ This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Date LEN, CLERK, By Deputy Clerk WAR�IG (Gov. code section 913). Subject to certain exceptions,you have only six(6) months from the date this notice was personally served or deposited in the mail to file a covet action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of'your choice in connection wide this matter. If you want to consult an attorney,you should do so immediately. *For Additioial Warning See Reverse Side ofThis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DateCULLEN, CLERK B y eputy Clerk BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By: Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) JUL 0 3 2008 District) CLERK BOARD OF SUPERVISOAS (Fill in the name) j CONTRA COSTA Co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 5 3a. a o o and in support of this claim represents as follows: 1. When did thedamage or in1ury occur? (Give exact date and hour) - Ua� tGQ 2°0 aoX, ��lne0 1oQ 2. Where did the damage or injury occur? (Include city and county) ` s� Vo e'a" 04. Pa e tiero, Go h logo co s� coUny, C o,I i �orn;a.. 40"( s.# 3. How did the damage or injury occur? (Give full details; use extra paper if reuired) � �-owo.vd�ewer'' Ave, Z �k¢1 OLFf ro ac kod o, tt ri Vt; W w aVt'+' Grl� IVtj.Aiid_ woos arceot o �o o�t'ov d ►^�v� abhou �; Peon farwo..y�{. oyk 0.4: � a�Y tSj nq �. +w0 eora� , c.�e✓bl� r�L+vr�s 4. What particular act or omission ori t e part of county or district officers, seryan s, or employees caused the injury or damage?11ie 94-e lte S ax 4-e dig vc, wa. w u5 n 4 cF lLv ot eP� resV41kI tK fie, e�c,G't�eta 5 What are the names of county or district officers, servants, or employees causing the damage or injury? .NlA b a+ti )ef4 moL r►`5hL 1'%S 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) JQ, � ►^�5hid ,I�I�C�vres to l le�S Yesv(f Jo Svr�-ev�� y,�_ �►ed;r &Q, 40,nn tvkre +-9 1,f 0c.f d. i't, I e P 7. How was the amount claimed above co m ut a, ed? (Include the estimated amount of any prospective injury or damage.)#j' ZI t go 1 (,�4vipv�ed t!i +k fG��'�hcC;�- del'arJ�r►� ��rth mvlr,rne�.,cad ce ttr Co•h Card (ant A AC 404da" e- , 8. Names and addresses of witnesses, doctors, and hospitals: C y lQ44CL Ke,IG"s e c a Lz �a`'E rE�f� �D�r tMo-wed�L GOhC,aV�,f.�c�ln�rA 9. List the expenditures you made on account of this accident or injury: vS� y�ade�o DATE TIME AMOUNT o ;t sM Zl'�i 3�O 01 w alnvj ci t 1,a� ) Gov. Code Sec. 910.2 provides "The claim shall be ) signed by the claimant or by some person on his ) beh " SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) (Claimant's Signature) KgAb eh 0, Ple-0.s.A u,��, :� gW,z3 (Address) 3 -�k� g ��) 0s-y� Telephone No. ) Telephone No. GzS� (� ..................................................................................... PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. MEMENEMEMMOMMENEEME mass so 0 an 0 0 MEN now M1 NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. �f F f'�4�{ i,. �w : - .1 f *. 2008 6 2I. i 71, 2006. 6 20 t tt A 7 � b Z7 4-1 �•?; � y�4 : ,r 2600 6 20 v r. .�' 2008 6 20 _ t JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 1 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/16/08 46192043 CONDITIONER SKIN ALOE PMM48852 1 4 . 00 01/16/08 90000308 EMERGENCY RM LEVEL, 5 99285 1 3619.50 01/16/08 474101001 HEMODIALYSIS I/P 90935 1 2589.50 01/16/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/16/08 50142959 SODIUM 84295 1 116.75 01/16/08 50141407 POTASSIUM 84132 1 116.75 01/16/08 50124353 CHLORIDE 82435 1 70.50 01/16/08 50100197 TOTAL CO2 82374 1 70.50 01/16/08 50145200 BUN 84520 1 163.00 01/16/08 50199991 CREATININE 82565 1 163 .00 01/16/08 50143304 GLUCOSE RANDOM 82947 1 118 .75 01/16/08 50110006 MAGNESIUM 83735 1 160.00 01/16/08 50199967 CALCIUM 82310 1 140 .75 01/16/08 50199942 PHOSPHORUS 84100 1 140.75 01/16/08 50199983 ALBUMIN 82040 1 140 .75 01/16/08 50143304 GLUCOSE RANDOM 82947 1 118.75 01/16/08 70003801 CALCITRIOL CAP 0.25MCG 8 190.84 01/16/08 70003833 CALCIUM CARBONATE 750MG TAB 10 80 .40 01/16/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/16/08 70005830 CLOPIDOGREL 75MG 2 81. 90 01/16/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 3 266. 10 01/16/08 70011119 FOLIC ACID 1MG 2 27 .40 01/16/08 70012711 HYDROMORPHONE INJ 2MG J1170 6 538 .74 01/16/08 70014285 LEVETIRACETAM TABLET 500MG 2 64 . 00 01/16/08 70014360 LEVOTHYROXINE .05MG 2 32 . 10 01/16/08 70014860 LIDOCAINE TOPICAL PATCH 5% -2 -85 .08 01/16/08 70014860 LIDOCAINE TOPICAL PATCH 5% 4 170.16 01/16/08 70019377 ONDANSETRON INJ 4MG J2405 3 279.75 01/16/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/16/08 70019737 PANTOPRAZOLE TABLET 40MG 2 76.28 01/16/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 2 29.04 01/16/08 70022363 PROMETHAZINE INJ 25MG J2550 -1 -91.33 01/16/08 70022363 PROMETHAZINE INJ 25MG J2550 2 182 .66 01/16/08 70023779 SEVELAMER TABLET 800MG 3 75.69 01/16/08 70030879 AZTREONAM INJ 1GM/5ML 2 322 .40 01/16/08 70070339 DEXT5% WATER 50ML BAG 2 350. 00 01/16/08 70072657 VANCOMYCIN PMX ADVANTG 1GM 1 106 .49 01/16/08 70073358 AMLODIPINE/NORASC 5MG 2 57 . 04 01/16/08 70074505 DEXT5% WATER ADDVANTAGE 250ML 1 175.00 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 2 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/16/08 63735501 FEMUR RT 73550 1 377 .25 01/16/08 63735907 TIBIA + FIBULA RT 73590 1 369.75 01/16/08 63735906 TIBIA + FIBULA LT 73590 1 369.75 01/16/08 25000019 ROOM RATE MEDSURG; ROOM 5206/MS 1 5375.00 01/16/08 46517751 IV PUMPSET WO FILTER PMM2113 1 119.75 01/16/08 70070669 NACL 0.9% 250 ML BAG J7050 1 174 .50 01/16/08 46101705 PACK ICE STAY-DRY LG PMM1015 1 26.50 01/16/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/16/08 70003833 CALCIUM CARBONATE 750MG TAB -10 -80.40 01/16/08 70012224 HEPARIN 1000U/ML IML J1644 2 43 .12 01/16/08 70015383 MANNITOL INJ 25°% 12.5GM J2150 2 181. 06 01/16/08 70023779 SEVELAMER TABLET 800MG -4 -100. 92 01/16/08 70070875 LIDOCAINE 1% 20ML VIAL 1 86.89 01/16/08 70072657 VANCOMYCIN PMX ADVANTG 1GM -1 -106.49 01/16/08 70074505 DEXT5% WATER ADDVANTAGE 250ML -1 -175.00 01/16/08 50670504 BLOOD CULTURE 87040 1 384 .25 01/16/08 50670504 BLOOD CULTURE 87040 1 384 .25 01/17/08 46192043 CONDITIONER SKIN ALOE PMM48852 1 4 .00 01/17/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/17/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/17/08 50142959 SODIUM 84295 1 116.75 01/17/08 50141407 POTASSIUM 84132 1 116.75 01/17/08 50124353 CHLORIDE 82435 1 70 .50 01/17/08 50100197 TOTAL CO2 82374 1 70.50 01/17/08 50110006 MAGNESIUM 83735 1 160. 00 01/17/08 50145200 BUN 84520 1 163 .00 01/17/08 50199991 CREATININE 82565 1 163 .00 01/17/08 50199967 CALCIUM 82310 1 140.75 01/17/08 50199942 PHOSPHORUS 84100 1 140.75 01/17/08 50199983 ALBUMIN 82040 1 140.75 01/17/08 50143304 GLUCOSE RANDOM 82947 1 118 .75 01/17/08 50199942 PHOSPHORUS 84100 1 140 .75 01/17/08 70000682 ALPRAZOLAM TAB 0.25MG 1 18.83 01/17/08 70003801 CALCITRIOL CAP 0.25MCG 6 143 .13 01/17/08 70003833 CALCIUM CARBONATE 750MG TAB 16 128.64 01/17/08 70004189 CARVEDILOL 6.25MG 2 60 .98 01/17/08 70007007 DARBEPOETIN ALFA INJ 200MCG J0881 1 1485. 97 01/17/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 5 443 .50 01/17/08 70012711 HYDROMORPHONE INJ 2MG J1170 8 718 .32 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 3 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/17/08 70014860 LIDOCAINE TOPICAL PATCH 5% 2 85. 08 01/17/08 70019377 ONDANSETRON INJ 4MG J2405 5 466.25 01/17/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/17/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 5 72 .61 01/17/08 70023779 SEVELAMER TABLET 800MG 3 75.69 01/17/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375.00 01/17/08 70070651 NACL 0. 9% 150ML BAG 1 174 .50 01/17/08 46517751 IV PUMPSET WO FILTER PMM2113 1 119.75 01/17/08 70003833 CALCIUM CARBONATE 750MG TAB -4 -32.16 01/17/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/18/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/18/08 70011119 FOLIC ACID 1MG 1 13 .70 01/18/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 .00 01/18/08 70014360 LEVOTHYROXINE . 05MG 1 16. 05 01/18/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38. 14 01/18/08 70030879 AZTREONAM INJ 1GM/5ML 1 161.20 01/18/08 70070339 DEXT5% WATER 50ML BAG 1 175. 00 01/18/08 70072657 VANCOMYCIN PMX ADVANTG 1GM 1 106.49 01/18/08 70073358 AMLODIPINE/NORASC 5MG 1 28.52 01/18/08 70073630 VANCOMYCIN INJ 500MG PREMIXED 1 95.95 01/18/08 70074489 D5%W ADD-VANTAGE 100ML 1 175. 00 01/18/08 70074505 DEXT5% WATER ADDVANTAGE 250ML 1 175. 00 01/18/08 46517751 IV PUMPSET WO FILTER PMM2113 1 119. 75 01/18/08 70070651 NACL 0 . 9% 150ML BAG 1 174 .50 01/18/08 46518502 SET TWINSITE EXTEN PMM34265 1 32 .00 01/18/08 46516209 SET PRIMARY PB PMM34261 1 32 .75 01/18/08 70070685 NACL 0.916 1000 ML BAG J7030 1 326. 00 01/18/08 50129501 VANCOMYCIN 80202 1 280.00 01/18/08 50142959 SODIUM 84295 1 116.75 01/18/08 50141407 POTASSIUM 84132 1 116.75 01/18/08 50124353 CHLORIDE 82435 1 70.50 01/18/08 50100197 TOTAL CO2 82374 1 70.50 01/18/08 50110006 MAGNESIUM 83735 1 160 .00 01/18/08 50145200 BUN 84520 1 163 . 00 01/18/08 50199991 CREATININE 82565 1 163 . 00 01/18/08 50199942 PHOSPHORUS 84100 1 140.75 01/18/08 50143304 GLUCOSE RANDOM 82947 1 118.75 01/18/08 50199967 CALCIUM 82310 1 140 .75 01/18/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 4 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/18/08 50192350 GLYCOHEMOGLOBIN 83036 1 136 .75 01/18/08 50199967 CALCIUM 82310 1 140 .75 01/18/08 50199967 CALCIUM 82310 -1 -140.75 01/18/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/18/08 50142959 SODIUM 84295 1 116.75 01/18/08 50141407 POTASSIUM 84132 1 116.75 01/18/08 50124353 CHLORIDE 82435 1 70.50 01/18/08 50100197 TOTAL CO2 82374 1 70.50 01/18/08 50110006 MAGNESIUM 83735 1 160 .00 01/18/08 50145200 BUN 84520 1 163 . 00 01/18/08 50199991 CREATININE 82565 1 163.00 01/18/08 50199967 CALCIUM 82310 1 140 .75 01/18/08 50199942 PHOSPHORUS 84100 1 140.75 01/18/08 50143304 GLUCOSE RANDOM 82947 1 118 .75 01/18/08 70003801 CALCITRIOL CAP 0.25MCG -2 -47 .71 01/18/08 70003801 CALCITRIOL CAP 0 .25MCG 6 143 .13 01/18/08 70003833 CALCIUM CARBONATE 750MG TAB 15 120.60 01/18/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/18/08 70005830 CLOPIDOGREL 75MG -1 -40. 95 01/18/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 6 532 .20 01/18/08 70010590 FENTANYL INJ 100MCG/2ML J3010 2 175 .44 01/18/08 70011119 FOLIC ACID 1MG -1 -13 . 70 01/18/08 70012083 SODIUM CHLORIDE 0 .9% INJ 10ML 3 141. 00 01/18/08 70012711 HYDROMORPHONE INJ 2MG J1170 13 1167.27 01/18/08 70013784 KANAMYCIN SULFATE INJ 1GM J1840 -6 -691.68 01/18/08 70013784 KANAMYCIN SULFATE INJ 1GM J1840 8 922 .24 01/18/08 70014285 LEVETIRACETAM TABLET 500MG -1 -32 .00 01/18/08 70014360 LEVOTHYROXINE . 05MG -1 -16 .05 01/18/08 70014860 LIDOCAINE TOPICAL PATCH 5% 3 127 .62 01/18/08 70015953 MEPERIDINE INJ 25MG J2175 1 87 .58 01/18/08 70019377 ONDANSETRON INJ 4MG J2405 6 559.50 01/18/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/18/08 70019737 PANTOPRAZOLE TABLET 40MG -1 -38 .14 01/18/08 70029541 SODIUM PHOSPHATE 4MEQ/ML 5 86.56 01/18/08 70070669 NACL 0.9% 250 ML BAG J7050 1 175.00 01/18/08 70073358 AMLODIPINE/NORASC 5MG -2 -57 .04 01/18/08 70073630 VANCOMYCIN INJ 500MG PREMIXED -1 -95. 95 01/18/08 70074489 D5%W ADD-VANTAGE 100ML -1 -175. 00 01/18/08 474101001 HEMODIALYSIS I/P 90935 1 2589.50 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 5 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/18/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65 .75 01/18/08 63711345 FLUORO > 1 HOUR 76001 1 1183 .50 01/18/08 63735609 KNEE LIMITED LT 73560 1 316 .25 01/18/08 63735610 KNEE LIMITED RT 73560 1 316 .25 01/18/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375.00 01/18/08 70003801 CALCITRIOL CAP 0 .25MCG -4 -95.42 01/18/08 70004189 CARVEDILOL 6.25MG -2 -60 .98 01/18/08 70005830 CLOPIDOGREL 75MG -1 -40. 95 01/18/08 70014285 LEVETIRACETAM TABLET 500MG -1 -32 .00 01/18/08 70014360 LEVOTHYROXINE .05MG -1 -16. 05 01/18/08 70070875 LIDOCAINE 1% 20ML VIAL 6 521.36 01/18/08 70073358 AMLODIPINE/NORASC 5MG -1 -28.52 01/18/08 70005343 CISATRACURIUM INJ J3490 1 62 . 14 01/18/08 70010590 FENTANYL INJ 100MCG/2ML J3010 1 87 .72 01/18/08 70010616 FENTANYL INJ 5ML J3010 1 88 .11 01/18/08 70011622 GLYCOPYRROL VIAL 1 88 .36 01/18/08 70016811 METOCLOPRAMIDE INJ 10MG J2765 1 87.96 01/18/08 70018270 NEOSTIGMINE 1:1000 VIAL J2710 1 90 . 15 01/18/08 70020540 PHENYLEPHRINE INJ 10MG J2370 1 87 . 90 01/18/08 70022769 PROPOFOL/DIPRIVAN INJ 200MG 1 119. 90 01/18/08 70023809 SEVOFLURANE/ULTANE 8 61.35 01/18/08 70030887 ESMOLOL/BREVIBLOC INJ 2 .5GM 1 333 .64 01/18/08 70070685 NACL 0.9% 1000 ML BAG J7030 1 326. 00 01/18/08 70071303 MIDAZOLAM INJ 2MG/ML J2250 1 88 .65 01/18/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/18/08 442100917 ORIF LOWER EXTREMITY 143 18780. 00 01/18/08 445100014 ANESTHESIA GENERAL 143 4028 .50 01/18/08 442200992 PACU LEVEL 2 36 936.00 01/18/08 442200993 PACU LEVEL 3 31 806 .00 01/18/08 442902020 PACK SURG GENERAL L4 1 312 . 00 01/18/08 442903583 STAPLER SKIN CLOSURE L2 1 94 . 00 01/18/08 442903356 ORTHO IMPLNT ANCHOR/SCREW L43 1 5874 .00 01/18/08 442903356 ORTHO IMPLNT ANCHOR/SCREW L43 1 5874 .00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 3 2730.00 01/18/08 442902010 DRAPE SURGICAL L2 1 94 .00 01/18/08 442903611 SUTURE SURGICAL L3 2 374 .00 01/18/08 442903611 SUTURE SURGICAL L3 2 374 .00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 3 2730 .00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 4 3640. 00 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 6 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 2 1820 .00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 2 1820.00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 2 1820. 00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 1 910 .00 01/18/08 442903317 ORTHO IMPLNT ANCHOR/SCREW L15 1 910.00 01/18/08 442903583 STAPLER SKIN CLOSURE L2 2 188.00 01/19/08 70003801 CALCITRIOL CAP 0 .25MCG 6 143 .13 01/19/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/19/08 70004189 CARVEDILOL 6 .25MG 2 60 . 98 01/19/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/19/08 70011119 FOLIC ACID 1MG 1 13 .70 01/19/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 .00 01/19/08 70014360 LEVOTHYROXINE . 05MG 1 16. 05 01/19/08 70014860 LIDOCAINE TOPICAL PATCH 5% 2 85.08 01/19/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/19/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38 . 14 01/19/08 70030879 AZTREONAM INJ 1GM/5ML 1 161.20 01/19/08 70070339 DEXT5% WATER 50ML BAG 1 175.00 01/19/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/19/08 472106506 EXER BREATH INCENTIVE EQUIP 1 86.25 01/19/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/19/08 50142959 SODIUM 84295 1 116. 75 01/19/08 50141407 POTASSIUM 84132 1 116.75 01/19/08 50124353 CHLORIDE 82435 1 70 .50 01/19/08 50100197 TOTAL CO2 82374 1 70 .50 01/19/08 50145200 BUN 84520 1 163 . 00 01/19/08 50199991 CREATININE 82565 1 163 .00 01/19/08 50199967 CALCIUM 82310 1 140.75 01/19/08 50199942 PHOSPHORUS 84100 1 140.75 01/19/08 50143304 GLUCOSE RANDOM 82947 1 118.75 01/19/08 50110006 MAGNESIUM 83735 1 160. 00 01/19/08 70000104 ACETAMINOPHEN TAB 325MG 2 16 .12 01/19/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 6 532 .20 01/19/08 70010633 FENTANYL 100MCG PATCH 1 123 .02 01/19/08 70012083 SODIUM CHLORIDE 0. 9% INJ 10ML 3 141.00 01/19/08 70012711 HYDROMORPHONE INJ 2MG J1170 11 987 .69 01/19/08 70019377 ONDANSETRON INJ 4MG J2405 6 559.50 01/19/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375. 00 01/19/08 46101705 PACK ICE STAY-DRY LG PMM1015 1 26.50 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 7 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/19/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/19/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/19/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/19/08 50670504 BLOOD CULTURE 87040 1 384 .25 01/19/08 50670504 BLOOD CULTURE 87040 1 384 .25 01/19/08 70014860 LIDOCAINE TOPICAL PATCH 516 -2 -85.08 01/19/08 70073358 AMLODIPINE/NORASC 5MG -1 -28.52 01/20/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/20/08 70011119 FOLIC ACID 1MG 1 13 .70 01/20/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 .00 01/20/08 70014360 LEVOTHYROXINE .05MG 1 16. 05 01/20/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38.14 01/20/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/20/08 70003801 CALCITRIOL CAP 0 .25MCG 6 143 . 13 01/20/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/20/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/20/08 70012083 SODIUM CHLORIDE 0 . 9% INJ 10ML 3 141. 00 01/20/08 70014860 LIDOCAINE TOPICAL PATCH 5% 2 85.08 01/20/08 70019510 OLMESARTAN 20MG TABLET 1 30 .40 01/20/08 70030879 AZTREONAM INJ 1GM/5ML 1 161.20 01/20/08 70070339 DEXT5% WATER 50ML BAG 1 175.00 01/20/08 46517751 IV PUMPSET WO FILTER PMM2113 1 119.75 01/20/08 70070651 NACL 0. 9% 150ML BAG 1 174 .50 01/20/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/20/08 50142959 SODIUM 84295 1 116.75 01/20/08 50141407 POTASSIUM 84132 1 116.75 01/20/08 50124353 CHLORIDE 82435 1 70 .50 01/20/08 50100197 TOTAL CO2 82374 1 70.50 01/20/08 50145200 BUN 84520 1 163 . 00 01/20/08 50199991 CREATININE 82565 1 163 .00 01/20/08 50143304 GLUCOSE RANDOM 82947 1 118 .75 01/20/08 50129501 VANCOMYCIN 80202 1 280.00 01/20/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/20/08 50700038 ABO/RH TYPE 86901 1 156 .75 01/20/08 50700350 ANTIBODY SCREEN 86850 1 170.25 01/20/08 50700459 CROSSMATCH SCREEN 86920 2 714 . 00 01/20/08 70000104 ACETAMINOPHEN TAB 325MG 6 48.36 01/20/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 7 620. 90 01/20/08 70012711 HYDROMORPHONE INJ 2MG J1170 12 1077 .48 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 8 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/20/08 70014477 LEVOFLOXACIN PREMIX 500MG J1956 1 288 .50 01/20/08 70014860 LIDOCAINE TOPICAL PATCH 5% -2 -85.08 01/20/08 70019377 ONDANSETRON INJ 4MG J2405 7 652 .75 01/20/08 70028360 VANCOMYCIN 500MG INJ 1 96. 15 01/20/08 70030879 AZTREONAM INJ 1GM/5ML -1 -161.20 01/20/08 70070024 ALBUMIN 5°% 250ML P9045 1 315 .93 01/20/08 70070339 DEXTS% WATER 50ML BAG -1 -175.00 01/20/08 70070644 NACL 0. 9% 100ML BAG 1 175.00 01/20/08 474101001 HEMODIALYSIS I/P 90935 1 2589.50 01/20/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/20/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375.00 01/20/08 52000023 RBC,LEUKOPOOR 1 246. 00 01/20/08 70028360 VANCOMYCIN 500MG INJ -1 -96. 15 01/20/08 70070644 NACL 0. 9% 100ML BAG -1 -175 .00 01/20/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/20/08 50310010 COMPLETE BLOOD COUNT 85025 -1 -193 .75 01/21/08 70005830 CLOPIDOGREL 75MG 1 40 . 95 01/21/08 70011119 FOLIC ACID 1MG 1 13 .70 01/21/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 . 00 01/21/08 70014360 LEVOTHYROXINE .05MG 1 16. 05 01/21/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38 .14 01/21/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/21/08 46101705 PACK ICE STAY-DRY LG PMM1015 2 53 .00 01/21/08 70070669 NACL 0. 9% 250 ML BAG J7050 1 174 .50 01/21/08 46482501 SET PUMP Y BLOOD PMM48321 1 40 .75 01/21/08 52000023 RBC,LEUKOPOOR 1 246 . 00 01/21/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/21/08 50388883 WESTERGREN SED RATE 85651 1 140 .75 01/21/08 50142959 SODIUM 84295 1 116 .75 01/21/08 50141407 POTASSIUM 84132 1 116.75 01/21/08 50124353 CHLORIDE 82435 1 70.50 01/21/08 50100197 TOTAL CO2 82374 1 70.50 01/21/08 50110006 MAGNESIUM 83735 1 160 .00 01/21/08 50145200 BUN 84520 1 163 . 00 01/21/08 50199967 CALCIUM 82310 1 140.75 01/21/08 50199942 PHOSPHORUS 84100 1 140.75 01/21/08 70003801 CALCITRIOL CAP 0 .25MCG 6 143 .13 01/21/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/21/08 70004189 CARVEDILOL 6.25MG 2 60. 98 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 9 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/21/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 6 532 .20 01/21/08 70012083 SODIUM CHLORIDE 0. 9% INJ 10ML 3 141.00 01/21/08 70012711 HYDROMORPHONE INJ 2MG J1170 10 897 . 90 01/21/08 70019377 ONDANSETRON INJ 4MG J2405 6 559.50 01/21/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/21/08 474101001 HEMODIALYSIS I/P 90935 1 2589.50 01/21/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/21/08 63710206 CHEST PA/LAT 71020 1 559.00 01/21/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375. 00 01/21/08 70004189 CARVEDILOL 6 .25MG -2 -60 .98 01/21/08 70019510 OLMESARTAN 20MG TABLET -1 -30.40 01/21/08 70070875 LIDOCAINE 1% 20ML VIAL 3 260.67 01/21/08 70073358 AMLODIPINE/NORASC 5MG -1 -28 .52 01/22/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/22/08 70011119 FOLIC ACID 1MG 1 13 .70 01/22/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 .00 01/22/08 70014360 LEVOTHYROXINE . 05MG 1 16. 05 01/22/08 70014477 LEVOFLOXACIN PREMIX 500MG J1956 1 288.50 01/22/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38 .14 01/22/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/22/08 46254009 DRESSING GZ 2X2 8PLY PMM1176 A6402 1 4 . 00 01/22/08 46293007 TAPE MICROPORE 1 PMM1206 A4450 1 4 . 00 01/22/08 70003801 CALCITRIOL CAP 0 .25MCG 6 143 . 13 01/22/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 . 36 01/22/08 70004189 CARVEDILOL 6.25MG 2 60.98 01/22/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 7 620. 90 01/22/08 70012083 SODIUM CHLORIDE 0 .9% INJ 10ML 3 141.00 01/22/08 70012711 HYDROMORPHONE INJ 2MG J1170 11 987 .69 01/22/08 70019377 ONDANSETRON INJ 4MG J2405 7 652.75 01/22/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/22/08 50129501 VANCOMYCIN 80202 1 280.00 01/22/08 85008423 PT EVALUATION 30 MIN 97001 1 180 .25 01/22/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375. 00 01/22/08 70003801 CALCITRIOL CAP 0 .25MCG -2 -47 .71 01/22/08 70004189 CARVEDILOL 6.25MG -1 -30.49 01/22/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/23/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/23/08 70011119 FOLIC ACID 1MG 1 13 .70 01/23/08 70014285 LEVETIRACETAM TABLET 500MG 1 32.00 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 10 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/23/08 70014360 LEVOTHYROXINE .05MG 1 16.05 01/23/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38. 14 01/23/08 70073358 AMLODIPINE/NORASC 5MG 1 28.52 01/23/08 46952925 DRESSING KERLIX PMM15500 A6403 6 61.50 01/23/08 46017000 BANDAGE ELASTIC 6" PMM1131 2 60.50 01/23/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/23/08 50388883 WESTERGREN SED RATE 85651 1 140.75 01/23/08 50142959 SODIUM 84295 1 116 .75 01/23/08 50141407 POTASSIUM 84132 1 116.75 01/23/08 50124353 CHLORIDE 82435 1 70 .50 01/23/08 50100197 TOTAL CO2 82374 1 70.50 01/23/08 50110006 MAGNESIUM 83735 1 160. 00 01/23/08 50145200 BUN 84520 1 163 .00 01/23/08 50199991 CREATININE 82565 1 163 . 00 01/23/08 50199942 PHOSPHORUS 84100 1 140 . 75 01/23/08 50199983 ALBUMIN 82040 1 140 .75 01/23/08 50143304 GLUCOSE RANDOM 82947 1 118 .75 01/23/08 70003801 CALCITRIOL CAP 0.25MCG 6 143 .13 01/23/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/23/08 70004189 CARVEDILOL 6 .25MG 2 60 .98 01/23/08 70007007 DARBEPOETIN ALFA INJ 200MCG J0881 1 1485 . 97 01/23/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 8 709.60 01/23/08 70012083 SODIUM CHLORIDE 0 .9% INJ 10ML 3 141. 00 01/23/08 70012711 HYDROMORPHONE INJ 2MG J1170 16 1436.64 01/23/08 70019377 ONDANSETRON INJ 4MG J2405 8 746.00 01/23/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/23/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 12 174 .28 01/23/08 70029541 SODIUM PHOSPHATE 4MEQ/ML 5 86.56 01/23/08 70070347 DEXT5°s WATER 100ML BAG 1 175. 00 01/23/08 474101001 HEMODIALYSIS I/P 90935 1 2589.25 01/23/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375.00 01/23/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65 .75 01/23/08 70004189 CARVEDILOL 6.25MG -1 -30.49 01/23/08 70012224 HEPARIN 1000U/ML 1ML J1644 2 43 .12 01/23/08 70019510 OLMESARTAN 20MG TABLET -1 -30.40 01/23/08 70070875 LIDOCAINE 1% 20ML VIAL 1 86.89 01/24/08 70005830 CLOPIDOGREL 75MG 1 40 . 95 01/24/08 70011119 FOLIC ACID 1MG 1 13 .70 01/24/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 .00 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 11 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/24/08 70014360 LEVOTHYROXINE . 05MG 1 16 .05 01/24/08 70014477 LEVOFLOXACIN PREMIX 500MG J1956 1 288 .50 01/24/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38. 14 01/24/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/24/08 46254009 DRESSING GZ 2X2 8PLY PMM1176 A6402 2 8 .00 01/24/08 85008076 PT-THER.PRO 1+AREAS EA 15 MIN 97110 2 157 . 00 01/24/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/24/08 70003801 CALCITRIOL CAP 0.25MCG -6 -143 .13 01/24/08 70003801 CALCITRIOL CAP 0 .25MCG 6 143 .13 01/24/08 70003802 CALCITRIOL CAPSULE 0.5MCG 3 90 . 93 01/24/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72.36 01/24/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/24/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 7 620.90 01/24/08 70012083 SODIUM CHLORIDE 0. 9% INJ 10ML 3 141.00 01/24/08 70012711 HYDROMORPHONE INJ 2MG J1170 14 1257 . 06 01/24/08 70014477 LEVOFLOXACIN PREMIX 500MG J1956 -1 -288 .50 01/24/08 70019377 ONDANSETRON INJ 4MG J2405 6 559.50 01/24/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/24/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 9 130 .71 01/24/08 50142959 SODIUM 84295 1 116.75 01/24/08 50141407 POTASSIUM 84132 1 116 .75 01/24/08 50124353 CHLORIDE 82435 1 70.50 01/24/08 50100197 TOTAL CO2 82374 1 70.50 01/24/08 50145200 BUN 84520 1 163 . 00 01/24/08 50199991 CREATININE 82565 1 163 . 00 01/24/08 50110006 MAGNESIUM 83735 1 160 .00 01/24/08 50199967 CALCIUM 82310 1 140.75 01/24/08 50199942 PHOSPHORUS 84100 1 140.75 01/24/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/24/08 50388883 WESTERGREN SED RATE 85651 1 140.75 01/24/08 50992239 PTH-INTACT */X 83970 1 40.52 01/24/08 50601046 C DIFFICILE TOXIN 87230 1 261.50 01/24/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375.00 01/24/08 70003833 CALCIUM CARBONATE 750MG TAB -3 -24 .12 01/24/08 70019510 OLMESARTAN 20MG TABLET -1 -30 .40 01/25/08 70005830 CLOPIDOGREL 75MG 1 40 . 95 01/25/08 70011119 FOLIC ACID 1MG 1 13 .70 01/25/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 . 00 01/25/08 70014360 LEVOTHYROXINE .05MG 1 16. 05 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 12 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/25/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38 .14 01/25/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/25/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/25/08 50142959 SODIUM 84295 1 116.75 01/25/08 50141407 POTASSIUM 84132 1 116.75 01/25/08 50124353 CHLORIDE 82435 1 70 .50 01/25/08 50100197 TOTAL CO2 82374 1 70.50 01/25/08 50145200 BUN 84520 1 163 . 00 01/25/08 50199991 CREATININE 82565 1 163 .00 01/25/08 50143304 GLUCOSE RANDOM 82947 1 118.75 01/25/08 70003802 CALCITRIOL CAPSULE 0.5MCG 3 90.93 01/25/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/25/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/25/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 7 620 .90 01/25/08 70010633 FENTANYL 100MCG PATCH -1 -123 . 02 01/25/08 70010633 FENTANYL 100MCG PATCH 1 123 . 02 01/25/08 70012083 SODIUM CHLORIDE 0 . 9% INJ 10ML 3 141.00 01/25/08 70012711 HYDROMORPHONE INJ 2MG J1170 14 1257 .06 01/25/08 70019377 ONDANSETRON INJ 4MG J2405 7 652 .75 01/25/08 70019510 OLMESARTAN 20MG TABLET -1 -30.40 01/25/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/25/08 70021349 POTASSIUM PHOSPHATE TAB 250MG -3 -43 .57 01/25/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 9 130.71 01/25/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375. 00 01/25/08 474101001 HEMODIALYSIS I/P 90935 1 2589.25 01/25/08 70004189 CARVEDILOL 6.25MG -1 -30 .49 01/25/08 70012224 HEPARIN 1000U/ML 1ML J1644 1 43 . 00 01/25/08 70070875 LIDOCAINE 196 20ML VIAL 1 86.89 01/25/08 70073358 AMLODIPINE/NORASC 5MG -1 -28 .52 01/26/08 70003802 CALCITRIOL CAPSULE 0.5MCG 3 90 . 93 01/26/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/26/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/26/08 70005830 CLOPIDOGREL 75MG 1 40 .95 01/26/08 70011119 FOLIC ACID 1MG 1 13 .70 01/26/08 70012083 SODIUM CHLORIDE 0 . 996 INJ 10ML 3 141. 00 01/26/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 . 00 01/26/08 70014360 LEVOTHYROXINE . 05MG 1 16.05 01/26/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/26/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38. 14 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 13 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/26/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 9 130.71 01/26/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/26/08 46101705 PACK ICE STAY-DRY LG PMM1015 2 53 .00 01/26/08 46101705 PACK ICE STAY-DRY LG PMM1015 2 53 . 00 01/26/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/26/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/26/08 50142959 SODIUM 84295 1 116.75 01/26/08 50141407 POTASSIUM 84132 1 116.75 01/26/08 50124353 CHLORIDE 82435 1 70 .50 01/26/08 50100197 TOTAL CO2 82374 1 70.50 01/26/08 50110006 MAGNESIUM 83735 1 160.00 01/26/08 50145200 BUN 84520 1 163 . 00 01/26/08 50199991 CREATININE 82565 1 163 .00 01/26/08 50199967 CALCIUM 82310 1 140.75 01/26/08 50199942 PHOSPHORUS 84100 1 140 .75 01/26/08 50199983 ALBUMIN 82040 1 140 .75 01/26/08 50155506 THYROID STIMULATING HORMONE 84443 1 223 .50 01/26/08 70000682 ALPRAZOLAM TAB 0 .25MG 1 18. 83 01/26/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 8 709.60 01/26/08 70012711 HYDROMORPHONE INJ 2MG J1170 16 1436 .64 01/26/08 70015342 MAGNESIUM OXIDE 400MG 2 16.46 01/26/08 70019377 ONDANSETRON INJ 4MG J2405 7 652 .75 01/26/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375. 00 01/26/08 70073358 AMLODIPINE/NORASC 5MG -1 -28 .52 01/27/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/27/08 70011119 FOLIC ACID 1MG 1 13 .70 01/27/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 . 00 01/27/08 70014360 LEVOTHYROXINE . 05MG 1 16. 05 01/27/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38. 14 01/27/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/27/08 70003802 CALCITRIOL CAPSULE 0.5MCG 3 90. 93 01/27/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72.36 01/27/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/27/08 70012083 SODIUM CHLORIDE 0 . 9% INJ 10ML 3 141.00 01/27/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/27/08 70021349 POTASSIUM PHOSPHATE TAB 250MG 9 130 .71 01/27/08 70070669 NACL 0. 9% 250 ML BAG J7050 1 174 .50 01/27/08 46517751 IV PUMPSET WO FILTER PMM2113 1 119.75 01/27/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 14 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/27/08 50388883 WESTERGREN SED RATE 85651 1 140 .75 01/27/08 50142959 SODIUM 84295 1 116 .75 01/27/08 50141407 POTASSIUM 84132 1 116. 75 01/27/08 50124353 CHLORIDE 82435 1 70.50 01/27/08 50100197 TOTAL CO2 82374 1 70.50 01/27/08 50110006 MAGNESIUM 83735 1 160. 00 01/27/08 50145200 BUN 84520 1 163 .00 01/27/08 50199991 CREATININE 82565 1 163 .00 01/27/08 50199967 CALCIUM 82310 1 140.75 01/27/08 50199942 PHOSPHORUS 84100 1 140.75 01/27/08 50388883 WESTERGREN SED RATE 85651 -1 -140.75 01/27/08 50388883 WESTERGREN SED RATE 85651 1 140.75 01/27/08 50388883 WESTERGREN SED RATE 85651 -1 -140.75 01/27/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 8 709.60 01/27/08 70012711 HYDROMORPHONE INJ 2MG J1170 15 1346 .85 01/27/08 70015342 MAGNESIUM OXIDE 400MG 2 16 .46 01/27/08 70015369 MAGNESIUM 2GM IN WATER 50ML J3475 1 288.50 01/27/08 70019377 ONDANSETRON INJ 4MG J2405 8 746 .00 01/27/08 70021349 POTASSIUM PHOSPHATE TAB 250MG -9 -130 .71 01/27/08 85008076 PT-THER.PRO 1+AREAS EA 15 MIN 97110 2 157 .00 01/27/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/27/08 25000019 ROOM RATE MEDSURG; ROOM 5220/MS 1 5375. 00 01/27/08 46290508 TAPE CLEAR 2 A4450 1 19.50 01/28/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/28/08 70011119 FOLIC ACID 1MG 1 13 .70 01/28/08 70014285 LEVETIRACETAM TABLET 500MG 1 32. 00 01/28/08 70014360 LEVOTHYROXINE . 05MG 1 16 .05 01/28/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38 . 14 01/28/08 70073358 AMLODIPINE/NORASC 5MG 1 28.52 01/28/08 474101001 HEMODIALYSIS I/P 90935 1 2589.25 01/28/08 85008076 PT-THER.PRO 1+AREAS EA 15 MIN 97110 2 157.00 01/28/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 01/28/08 70003802 CALCITRIOL CAPSULE 0 .5MCG 3 90.93 01/28/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/28/08 70004189 CARVEDILOL 6.25MG 2 60 .98 01/28/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 8 709.60 01/28/08 70010633 FENTANYL 100MCG PATCH -1 -123 .02 01/28/08 70010633 FENTANYL 100MCG PATCH 1 123 . 02 01/28/08 70012083 SODIUM CHLORIDE 0.9% INJ 10ML 3 141. 00 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 15 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/28/08 70012711 HYDROMORPHONE INJ 2MG J1170 13 1167.27 01/28/08 70015342 MAGNESIUM OXIDE 400MG 2 16.46 01/28/08 70019377 ONDANSETRON INJ 4MG J2405 8 746. 00 01/28/08 70019510 OLMESARTAN 20MG TABLET 1 30 .40 01/28/08 50388883 WESTERGREN SED RATE 85651 1 140 .75 01/28/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/28/08 50142959 SODIUM 84295 1 116 .75 01/28/08 50141407 POTASSIUM 84132 1 116 .75 01/28/08 50124353 CHLORIDE 82435 1 70.50 01/28/08 50100197 TOTAL CO2 82374 1 70 .50 01/28/08 50145200 BUN 84520 1 163 .00 01/28/08 50199991 CREATININE 82565 1 163 . 00 01/28/08 50143304 GLUCOSE RANDOM 82947 1 118 .75 01/28/08 25000019 ROOM RATE MEDSURG; ROOM 5206/MS 1 5375. 00 01/28/08 46017000 BANDAGE ELASTIC 6" PMM1131 3 90 .75 01/28/08 46016002 BANDAGE ELASTIC 3" PMM1129 -3 -51.75 01/28/08 70003833 CALCIUM CARBONATE 750MG TAB -3 -24 . 12 01/28/08 70004189 CARVEDILOL 6 .25MG -1 -30.49 01/28/08 70070875 LIDOCAINE 1% 20ML VIAL 1 86 .89 01/28/08 70073358 AMLODIPINE/NORASC 5MG -1 -28 .52 01/29/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/29/08 70011119 FOLIC ACID 1MG 1 13 .70 01/29/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 .00 01/29/08 70014360 LEVOTHYROXINE . 05MG 1 16.05 01/29/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38 . 14 01/29/08 70073358 AMLODIPINE/NORASC 5MG 1 28.52 01/29/08 50310010 COMPLETE BLOOD COUNT 85025 1 193 .75 01/29/08 50142959 SODIUM 84295 1 116.75 01/29/08 50141407 POTASSIUM 84132 1 116 .75 01/29/08 50124353 CHLORIDE 82435 1 70 .50 01/29/08 50100197 TOTAL CO2 82374 1 70.50 01/29/08 50110006 MAGNESIUM 83735 1 160. 00 01/29/08 50145200 BUN 84520 1 163 .00 01/29/08 50199991 CREATININE 82565 1 163 . 00 01/29/08 50199967 CALCIUM 82310 1 140.75 01/29/08 50199942 PHOSPHORUS 84100 1 140.75 01/29/08 50121458 PREALBUMIN 84134 1 163 .75 01/29/08 70003802 CALCITRIOL CAPSULE 0 .5MCG -3 -90.93 01/29/08 70003802 CALCITRIOL CAPSULE 0.5MCG 3 90.93 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 16 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 01/29/08 70003833 CALCIUM CARBONATE 750MG TAB -6 -48 .24 01/29/08 70003833 CALCIUM CARBONATE 750MG TAB 9 72 .36 01/29/08 70004189 CARVEDILOL 6.25MG 2 60. 98 01/29/08 70005830 CLOPIDOGREL 75MG -1 -40. 95 01/29/08 70005830 CLOPIDOGREL 75MG 1 40. 95 01/29/08 70007007 DARBEPOETIN ALFA INJ 200MCG J0881 -1 -1485 .97 01/29/08 70007007 DARBEPOETIN ALFA INJ 200MCG J0881 1 1485. 97 01/29/08 70008602 DIPHENHYDRAMINE INJ 50MG/ML J1200 6 532 .20 01/29/08 70011119 FOLIC ACID 1MG -1 -13 .70 01/29/08 70011119 FOLIC ACID 1MG 1 13 .70 01/29/08 70012083 SODIUM CHLORIDE 0. 9% INJ 10ML -2 -94 .00 01/29/08 70012083 SODIUM CHLORIDE 0 .9% INJ 10ML 3 141.00 01/29/08 70012711 HYDROMORPHONE INJ 2MG J1170 8 718 .32 01/29/08 70014285 LEVETIRACETAM TABLET 500MG -1 -32 .00 01/29/08 70014285 LEVETIRACETAM TABLET 500MG 1 32 . 00 01/29/08 70014360 LEVOTHYROXINE . 05MG -1 -16.05 01/29/08 70014360 LEVOTHYROXINE . 05MG 1 16 .05 01/29/08 70015342 MAGNESIUM OXIDE 400MG -2 -16.46 01/29/08 70015342 MAGNESIUM OXIDE 400MG 2 16.46 01/29/08 70019377 ONDANSETRON INJ 4MG J2405 6 559.50 01/29/08 70019510 OLMESARTAN 20MG TABLET -1 -30.40 01/29/08 70019510 OLMESARTAN 20MG TABLET 1 30.40 01/29/08 70019737 PANTOPRAZOLE TABLET 40MG -1 -38. 14 01/29/08 70019737 PANTOPRAZOLE TABLET 40MG 1 38.14 01/29/08 70073358 AMLODIPINE/NORASC 5MG 1 28 .52 01/29/08 46254009 DRESSING GZ 2X2 8PLY PMM1176 A6402 1 4 . 00 01/29/08 70019510 OLMESARTAN 20MG TABLET -1 -30.40 01/29/08 50841551 VENIPUNCTURE, IP/ER 36415 1 65.75 03/14/08 CCHMCCA CC MANAGED MEDI-CAL CONT ADJ 1 -199550. 01 03/14/08 CCHMCPAY CC MANAGED MEDI-CAL PAYMENT 1 -27768.00 *** SUMMARY BY SERVICE *** SEMI PRIV RM/GEN 13 69875.00 PHARMACY 392 8789.32 IV SOLUTIONS 9 1573 .50 MED-SURG SUPPLIES 23 1811. 00 NON-STERILE/SUPPLY 2 99.50 STERILE SUPPLIES 17 736.50 H022159867 JOHN MUIR MED CNTR CONCORD P.O. Box 44000 Dept 44261 17 San Francisco, CA 94144 (925) 947-3336 FINAL INP DECIUS,ANGELA MARIE H022159867 01/16/08 01/29/08 02/16/08 DECIUS,ANGELA MARIE CCHP-MEDICAL 91238047A2 285 KATHLEEN DR PLEASANT HILL CA 94523 SUPPLY/IMPLANTS 20 28128.00 LABORATORY 19 1340.25 LAB/CHEMISTRY 137 17655.52 LAB/IMMUNOLOGY 3 884 .25 LAB/HEMATOLOGY 18 3275.50 LAB/BACT-MICRO 5 1798.50 RADIOLOGY DIAG 6 2932 .75 DX X-RAY/CHEST 1 559. 00 O.R. SERVICES 143 18780.00 ANESTHESIA 143 4028 .50 BLOOD STOR & PROC 2 492 . 00 PHYSICAL THERp 6 471.00 PHYS THERP/EVAL 1 180.25 EMERGENCY ROOM 1 3619.50 DRUGS REQUIRING DETAILD CODING 399 40420.42 RECOVERY ROOM 67 1742.00 DIALYSIS/INPT 7 18125.75 RECEIPTS, ADJUSTMENTS, ETC. 2 -227318 . 01 H022159867 227318 . 01 -227318 .01 0. 00 0. 00 0 . 00 JOHN MUIR H E A L T H John Muir Medical Canter Concord Campus 2540 East Street Concord,CA 94520 T. (925)682-8200 RE-DISCLOSURE STATEMENT THE INFORMATION THAT HAS BEEN PROVIDED TO YOU IS CONFIDENTIAL AND ONLY FOR THE PERSON TO WHOM IT IS ADDRESSED. YOU MAY NOT MAKE ANY FURTHER RE- DISCLOSURES OF THIS INFORMATION WITHOUT A WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS, OR AS OTHERWISE PERMITTED BY APPLICABLE STATE LAW. IF THESE RECORDS INCLUDE INFORMATION WHICH IS PROTECTED BY FEDERAL REGULATIONS (42 C.F.R. PART 2 OR CALIFORNIA WELFARE & INSTITUTIONS CODE 5328), A GENERAL AUTHORIZATION IS NOT SUFFICIENT FOR THIS PURPOSE. illllllllllllllllllll�l�illllllll Printed: 01/29/08 at 1256 2PTIN John Muir Heat - Concord Campus Discharge Medication Reconciliation Page: 1 MR#: H017290 Patient: DECIUS ANGELA MARIE Admitted: 01/16/08 1409 Acct: H022159867 Location: B5 - 5206-1 Administrative Data ALLERGIES: PCN.PHENERGAN, TEGADERM/TAPE• ADHESIVE-BLISTERS ALLERGIES CONT.: ALL ERGY/RXN: PCN - HIVES: PHENERGAN-TWITCHING: EPHEDRINE: MORPHINE ALLERGY/RXN: CEPHALSPORINS OK PER DR EIN 9/06. LIDOCAINE-TINNITUS 1/26/08CS DIET ALLERGIES: PT DENIES ANY SEAFOOD ALLERGY For CHF and AMI patients with LVSD: Order ACEI or ARB or document contraindication. For AMI Patients: Order Aspirin and beta blacker or document contraindications. Vaccine Status: Pneumo Vacc Date . Flu Vacc Date . Physicians: Please check the appropriate box to indicate which medications to DC. Continue or Modify. The nurse will use this information to provide appropriate medicaton teaching at discharge and to pprovide the patient with a complete list of medications. Unmarked meds will NOT be included on the patient list. Home Meds ICont I DC IModify I specify I I I I Modifications /('list provided by patient/family at time of admission)ROT I 1 I I / 40MGONIX PC DAILY I I I I RENAGEL 800 MG PO TID W/MEAL 1 I I I / 75 MG I X 75 MG PO DAILY I i/ NICAR I I I 1120 MG PO NIGHTLY I I I I /DILAUD I I I !� 0A 611,kA &11 ^01/ /T C, F�F� r N 8YNTHROID ( I 50 MCG PO DAILY I 1 ,FENTANYL PATCH I I I / 100 MCG ON SKIN 072HRS I I FOLIC ACID I I I xNG PO DAILY I I I I / RENAGEL 800 MG PO W/MEALS fIORVASC I I I /5 MG PO DAILY EPPRA I I I l 00 MG PO DAILY I I I �YNTHROID Z I /50 MCG PO DAILY I 2MA8899 Printed: 01/29/08 at 1256 John Muir Healt - Concord Campus Discharge Medication Reconciliation Page: 2 MR#: H017290 Patient: DECIUS,ANGELA MARIE Admitted: 01/16/08 1409 Acct: H022159867 Location: B5 - 5206-1 (Cont I DC (Modify I Specify I I I I Modifications I I I I (cont I DC {Modify I specify Current Scheduled MEDS I I I I Modifications DARBEPOETIN ALFA I I ARANESP 200 MCG SUBCUT We@0900 l I I I OLMESARTAN MEDOXOMIL I I I I BENICAR I I I 20 MG PO BEDTIME NIGHTLY I CALCITRIOL I I I 0/5 MCG PO EVERY 8 HOURS I I I I /CARVEOIOROLCEG I 1 6.25 MG PO 2 TIMES DAILY WITH/AFTER MEALS { I I FENTANYL I I I DURAGESIC 100 MCG TRANSOERM. 03D@0900 I I I FOLIC ACID I MG PO DAILY I I I INSULIN ASPART I I I I HUMALOG or NOVOLOG Insulin I I I I 3AM Supplemental Humalog/Novolog SUBCUT 0300 I 1 I I INSULIN ASPART I I I I HUMALOG or NOVOLOG Insulin Bedtime Supplemental Humalog/Novolog SUBCUT BEDTIME I I NIGHTLY I I I I INSULIN ASPART I I I HUMALOG or NOVOLOG Insulin I I I IT f / Moderate Pre-meal Humalog/Novolog SUBCUT SUPPLEMENTAL ( I I I ffflt_�(! NOVOLOG INSULIN I I I LEVETIRACETAM { I I X5, KEPPRA 00 MG PO DAILY I I MAGNESIUM OXIDE I I I I — 400 MG PO EVERY 12 HOURS AMLODIPINE NORVASC I I 5 MG PO DAILY I I I CLOPIDOGREL I I I I PLAVIX 75 MG PO DAILY _f 2/13/ M9 Printed: 01/29/06 at 1256 John Muir Health - Concord Campus Discharge Medication Reconciliation Page: 3 MR#: H017290 Patient: DECIUS,ANGELA MARIE Admitted: 01/16/08 1409 Acct: H022159867 Location: B5 - 5206-1 Cont { DC IModify I Specify I I { Modifications I I I PANTOPRAZOLE I I I PROTONIX { I I 40 MG PO DAILY { { { SODIUM CHLORIDE 0.9% IV FLUSH I I I SALINE LOCK FLUSH { { { 10 ML FLUSH 0000,0800.1600 I { LEVOTHYROXINE I I I SYNTHROID.LEVOTHROIO I I 1 I 0.05 MG PO DAILY@0730 I I I I CALCIUM CARBONATE I { I TUMS I I I I 2250 MG PO 1000, 500.2000 I I I I Date Time Physician Signature i r { 2MA8809 Printed: 01/29/08 at 1256 John Muir Heat - Concord Campus Discharge Medication Reconciliation Page: 4 MR#: H017290 Patient; DECIUS,ANGELA MARIE Admitted: 01/16/08 1409 Acct: H022159867 Location: B5 - 5206-1 (Cont I DC (Modify I Specify L I Modifications I I I I New Prescriptions to be filled by outpatient pharmacy: Instructions for nurse: If prescriptions are ordered, give this page to the patient. Instructions for patient: Take this page to the pharmacy to fill ,your prescription(s). [ ] Triplicate provided to patient for: med: dose: route: freq: med: dose: route: freq: Drug Dose Frequency Route Dispense Quantity Physician (Print): Phone: Address: City: CA License: DEA: Date: Time: Physician Signature: - - - - PAGE 4 IS LAST PAGE - - - - � ` , , 7.', •a ♦. q..: ,.y...+-� N.•, ,r. -�;Y `.c'. ..r r!�it.�!�.w�•.-- ' 'i;• �i•'� {-•��j �� n:�l`:,T*v II�JI ullll!illi�I�ISI U 3PTIN RENAL FLUID OVERLOAD DISCHARGE INSTRUCTIONS v When your condition worsens or does not seem to be responding to treatment, taking action right away may prevent more serious illness or an emergency trip to the hospital. CALL YOUR PHYSICIAN IF: v You experience increased difficulty in breathing at rest,with activity, when lying down or you need more pillows to breath easier. v You have a dry hacking cough that does not go away. v You have increased swelling in your feet or legs. v New onset of swelling or discomfort in the abdomen v New onset of feeling tired all the time or decreased ability to do normal activities. v You are dizzy when you stand up. v You feel sick to your stomach or are vomiting. MEDICATIONS: TAKE YOUR MEDICATIONS AS PRESCRIBED v Do not make any changes without consulting your doctor. Always keep a list of your current medications with you in your wallet v Maintain at least one week's supply of medication at all times. ' v Call your doctor's office at least 48 hours in advance when you need refills v Store your medications in a cool dry place. DIET: AVOID FOODS THAT ARE HIGH IN SODIUM(SALT) v Examples are regular canned soups, potato chips, saltines, bacon, and most packaged frozen foods v Do not use salt in food preparation or with your meals v Check food labels for sodium (salt)content; use products marked"low salt'or"no salt". v When dining out ask that your order be prepared without salt v Do not use salt substitute.You may use 'Mrs, Dash"or"Papa Dash" seasoning. _ r v . Limit fluid intake to - _ - ml/day(240 ml=one 8 ounce glass:of fluid) v Ask your doctor if you may have alcohol WEIGHT MONITORING: DIALYSIS DRY WEIGHT: v Weigh yourself EVERY morning at the same time.Wear the same types of clothes each time. v Keep a record of your daily weight. Your weight is also monitored at the Dialysis clinic t FOLLOW-UP: ALWAYS KEEP YOUR DOCTOR'S APPOINTMENTS AFTER YOU ARE DISCHARGED v Call your doctor's office if you have any questions or concerns about your treatment once you are discharged v Keep all your dialysis appointments at the outpatient clinic. You are scheduled ACTIVITY: v Rule of thumb, resume normal daily activity as tolerated v Check with your doctor about an exercise program or enrolling in Cardiac Rehab classes v Pace yourself, give yourself enough time to get things done. v Avoid activity after meals or when the weather is very hot. NO SMOKING: Resources listed on back. For further assistance in stopping, contact your Primary Care Physician. I understand these instructions and have received a copy. Date 1 /� -Time PATIENT/CAREGIVER SIGNATURE-' Date I /^ h 7Time ' I -"RN SIGNATURE � �-- 111111111111111111111111{11111111111111111111111111111111111 ® JOHN M U I Rppg; 12128/67 401E I. B . LTH H017290 John Muir Medical Center DECIUS,ANGELA MARIE Concord CampusHp22159867 01116108 14:09 s:\ncAomis180098renalchldcinstructsmokelnl.doc 1115107 and HNE1634913222 Form Y 800986 new 6105 white-patient,Yellow-chart 2M3/HP Smoking Cessation Resources American Cancer Society — 925-934-7640 Lung Association — 925-935-0472 800-LUNG-USA Contra Costa County Health Dept health education- 925-431-2383 Health Department smoking cessation classes- 800-495-8885 Solano County Social Services health education-707-553-5890 Health Department smoking cessation classes- 800-287-7357 State of California-800-NO-BUTTS Spanish-800-456-6386 Chinese-Cantonese-Mandarin-800-838-8917 Vietnamese-800-778-8440 Korean-800-556-5564 Deaf-TDD-800-933-4833 Chewing tobacco-800-844-chew The Quit Smoking Center-925-648-7848 www.thequitsmokingcenter.com Nicotine Anonymous-877-879-6422 www.nicotineanonymous.org Smoke Enders-800-828-4357 ext. 1 National Board for Certified Clinical Hypnotherapists and licensed professional mental health counselors-800-449-8144 Kaiser Permanente: fee to non-members Pleasanton-925-847-5172 Walnut Creek-925-295-4190 Vallejo-707-651-2692 Fairfield-707-427-5777 Vacaville-707-453-5155 St Helena Health Center: 12-step program, 7-day live-in program, fee 800-358-9195 707-963-6207 Form#80094-2B, print back of Forms#800946&800988 2MAt8t899 Ifill 1111111111111111IN 4PTIN DIAGNOSIS: l ALLERGIES: DIET: ACTIVITY: N<s tolerated ❑ Daily walking ❑OK to drive ❑OK to shower ❑May resume sexual activity Precautions: EQUIPMENT:❑Cane ❑Crutches ❑Walker ❑Wheelchair ❑Bed ❑CPM ❑Bedside Commode ❑Oxygen Other: o Company delivering equipment: Phone: LAB WORK: Test(s): When: Where: SPECIAL INSTRUCTIONS: MEDICATIONS:❑ Take medications listed on page 2 Enter referral into Meditech: ❑ Home care ❑Cardiac Rehab 674-2200 ❑ Pulmonary Rehab 674-2351 REFERRALS: ❑ Diabetes Center 674-2077 Other: Call Or. �1.Q LOSS, For appointment in �Y days/weeks. Phone: . Call Dr. For appointment in days/weeks. Phone: CASE MANAGEMENT/HOME CARE: Home Care Agency: Phone: ❑ RN ❑ PT ❑Social Worker ❑OT ❑ST ❑ Home Health Aide Transportation home arranged via: ❑ Private Car ❑Wheelchair Transport ❑Gurney Transport ❑Ambulance COMMUNITY RESOURCE REFERRAL:-- El EFERRAL: _❑ Weigh yourself daily. Your weight when you were discharged: Follow the printed discharge instructions indicated: I , ❑ Acute Myocardial Infarction(Heart Attack) ❑American Heart Association Guidelines ❑Angioplasty/Stent ❑ Automatic Implantable Cardiac Defibrillator ❑Cardiac Surgery ❑Congestive Heart Failure C Pacemaker :❑Stroke Binder No smoking, smoking cessation resources are listed on back Vaccine received this hospitalization: ❑ Pneumovax ❑ Flu • Call 911 for emergencies ❑ Drug Monograph(s)provided ❑ Krames Instruction(s) provided • Call your physician if symptoms Instructions reviewed with: ❑ Patient ❑ Caregiver return or for questions & advice Take these instructions to your follow-up appointment or if you go to • Do not stop your medications the Emergency Department. without consulting your physician These discharge instructions have been explained to me and I understand them. I have receive a Fopygf these instructions. DATE TIME PHYSICIAN SIGNATURE ' DATETIM i ENT/�IAREII�VIITGNQURE_ 1 DATE TIME CASE MANAGER/HOME CARE COORDINATOR DATE � � 11��11111�11�Illllllll Illllllllll1111lIl�lllll` 77860 (10/22/07) r 111 11i I 11 I�lllll��l��l Authenticated by + l . ' ®JOHN H, Ileana A Helms MD H017290 DOB: ]2/28/B7 40/F DECIUS,ANGELA MARIE Conn Muir Modica]Canter On 02/07/2000 01 , 14, 10 PM H022159867 01/16/08 14:09 c�ncDISCHARGE HOME INSTRUCTIONS HNE1634913222 PAGE 1 OF 2 WHITE-PATIENT/YELLOW•CHART/PINK•PHYSICIAN ADDITIONAL INSTRUCTIONS: ADDITIONAL PRINTED DISCHARGE INSTRUCTIONS: MEDICATIONS & DOSE ROUTE FREQUENCY START ❑By Mouth ❑Daily ❑2 times a day ❑3 times a day` []Today at ❑4 times a day Other: 1'nomorrow ❑By Mouth ❑Daily ❑2 times a day ❑3 times a day ❑Today at ❑4 times a day Other: ❑Tomorrow ❑By Mouth []Daily ❑2 times a day ❑3 times a day ❑Today at ❑4 times a day Other: ❑Tomorrow ❑By Mouth ❑Daily ❑2 times a day O 3 times a day ❑Today at _ ❑4 times a day Other: 0 Tomorrow ❑By Mouth ❑Daily 112 times a day ❑3 times a day ❑Today at ❑4 times a day Other: ❑Tomorrow ❑By Mouth ❑Daily ❑2 times a day ❑3 times a day ❑Today at _ ❑4 times a day Other: _ _ ❑To-morrow ❑By Mouth ❑Daily �M 2 times a day ❑3 times a day ❑Today at __ ❑4 times_a day Other: _ _ El Tomorrow _ ❑By Mouth ❑Daily ❑2 times a day ❑3 times a day ❑Today at ❑4 times a day _Other: ❑Tomorrow ❑By Mouth ❑Daily [1 2 times a day ❑3 times a day ❑Today at ❑4 times a day Other: ❑Tomorrow PAI1 fl.RiEDICATION OR MEDICATION YO TAKE AS NEEDED: C]By Mouth Every hours as needed for pain May take next dose at _ E7 By Mouth Every hours as needed for pain May take next dose at ADDI'!'iQi� � L]U'."r".AT10K'S FOR CARDIOVASCULAR PATIENTS: rl By Mouth [-?Daily C 2 times a day Cl 3 times a day ❑Today at O Aspirin mg _ D 4 times a day Other: ❑Tomorrow ❑By Mouth F3 Daily [- 2 times a day ❑3 times a day []Today at _NA'AE OP ACE INIKWTOR_ __ E�4 times a day, Other: U Tomorrow El By Mouth ❑Daily 112 times a day ❑3 times a day ❑Today at NAME OF BETA BLOCKER ❑4 times a day Other: ❑Tomorrow ❑By Mouth ❑Daily ❑2 times a day EJ 3 times a day ❑Today at NAME OF CHOLESTEROL LOWERING DRUG ❑4 times a day Other: ❑Tomorrow ❑By Mouth ❑Daily 112 times a day ❑3 times a day EJ Today at NAME OF ANTI-PLATELET MEDICATION _ CJ 4 times a day Other: ❑Tomorrow ❑By Mouth ❑Daily ❑Today at NAME OF ANTI-COAGULANT GOAL INR ❑Tomorrow 77860 (10/22/07) ®JOHN MUIROlz f ti°, H E A L T H John Muir MWiwi Onto �y �/ r Concord Camcws of ` -l• ` DISCHARGE HOME INSTRUCTIONS D 22 I 1 PAGE 2 OF 2 02 WHITE-PATIENT/YELLOW•CHART/PINK•PHYSICIAN T�— Tobacco Cessation and Education Resources Stop Smoking Websites: http://www.nobutts.org www.quitnet.org Especially for teens: http://nobutts.ucsd.edu The California Smokers' Helpline English - 1-800-NO-BUTTS Spanish - 1-800-456-6386 (NO-FUME) Mandarin & Cantonese - 1-800-838-8917 Vietnamese - 1-800-778-8440 Korean - 1-800-556-5564 t TDD/TYY - 1-800-933-4833 Chewing Tobacco - 1-800-844-2439 It,. American Cancer Society Contra Costa Unit {• (925) 934-7640 1-800-227-2345 American Lung Association 1 (925) 935-0472 Contra Costa County Health Services Health Clinics (800) 495-8885-(for Contra Costa Health Plan participants) John'Muir Hospital (925) 484-4413 1: Nicotine Anonymous No. California Hot Line: (408) 236-2196 www.nica-norcal.org Kaiser Permanente Diablo Service Area (fee for non-members) ` Antioch: (925) 813-3560 Martinez: (925) 372-1198 Walnut Creek: (925) 906-2190 (925) 295-4190 Pleasanton: (925) 847-5172 Richmond: (510) 307-2210 77e60 (10/22/07) ®JOHN MUIR . ', , Il 11 `MI l 14l�l11111111141111111111�1�111�11111111111111 11��1111{{{1144 John Muir Medical Canty H017 290 DOB: 12123/67 40/F Concord Campus DECIUS,ANGELA MARL i DISCHARGE HOME INSTRUCTIONS H022159867 01116108 14:09 HNE1634913222 I I!1 i lllflll I/111111 I!illy � � � ! page of 1 PT!N Allergies/Reaction: ❑No Meds Info received from: ❑ Allergy Band ❑Latex Allergy Applied Unable to obtain Flu vaccine this Flu vaccine date Prior Pneumovax Pneumovax date Reason: flu season? ❑Y ❑N received? ❑Y ❑N Drug Dose Last Taken Discharge Instructions (Include herbal supplements and Over the Counter medications) Route:❑Mouth ❑ Shot ❑Other: El Stop. Do not take Fre : 1711/da ❑2/da ❑ 3/day ❑ 4/day❑As needed: ❑See new prescription Route:El Wuth ❑ Shot ❑ Other: _ D Stop. Do not take Freq: [11/da ❑2/day ❑ 3/da ❑ 4/da ❑As needed: _ ❑See new prescription Route: O Shot D Other: —— — ❑Stop. Do not take Freq: ❑ 1/da ❑2/da F-13/da El4/da El As needed: O See new prescription �W d ------------------ Route: D Mouth ❑ Shot ❑Other: ❑Stop. Do not take Freq: ❑ 1/day ❑2/da ❑ 3/day ❑4/day❑As needed: ❑See new prescription G ,�/ ----------------- Route: __ _____________Route:12 Mouth ❑ Shot ❑Other: _ ❑Stop. Do not take Freq: ❑ 1/day D 2/day ❑ 3/da ❑4/day ❑As needed: ❑See new prescription Route: ❑Ath D Shot -1-1—Of—her- T————V D Stop. Do not take Freq.: 111/daEl 2/day El 3/day D 4/da F-1Asneeded: ❑See new prescription Route:❑MShot 11 Other: —— — ❑Stop. Do not k p take Freq: ❑ 1/day ❑2/day ❑ 3/da ❑4/day❑As needed: ❑See new prescription Route:D Mouth ❑ Shot _E1_0 t—h e- r: El Stop. Do not take Freg: ❑ 1/day ❑2/da ❑3/day ❑4/day❑As needed: ❑See new prescription -------------------------- Route:❑Mouth ❑ Shot ❑Other: ❑Stop. Do not take Freq: ❑ 1/day O 2/da ❑3/day ❑ 4/day O As needed: ❑See new presci1ption RN/LVN Signature Date Other Date Although the physician has reviewed your medication list, except for the specific medication changes recommended by the physician we cannot comment or adjust medications prescribed by your primary care physician or other specialist physician(s). Please follow up with your primary care or specialist physician(s), who is responsible for your general care and all other medical conditions, as well as for any continuing or long-term care. TAKE THIS FORM TO THE NEXT PROVIDER OF CARE IPRESENTEE$TEI 7816 (3/27/07) ATENCION MEDIC f I,III�II`Illilllllll`��l`I"If�III,III„II`II`I`}f IIIII`II� ®JOHN MUIR H017290 DOB: 12/26/67 40/F John Muir Medical Center DECIUS,ANGELA MARIE Concord Campus H022159867 01/16/08 14:09 PATIENT MEDICATION LIST HNE1634913222 CHART COPY John Muir Health Inpatient Discharge Instructions John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Take these Instructions to your follow-up appointment or if you go to the Emergency Room. Patient Name: ANGELA MARIE DECIUS Attending Dr: ILEANA A. HELMS Birthdate: 12/28/67 Admit Date: 01/16/08 Flu Vaccine: Account #: H022159867 Pneumovax: Unit #: H017290 Pharmacy Allergies: PCN = HIVES; PHENERGAN=TWITCHING; EPHEDRINE; MORPHINE CEPHALSPORINS OK PER DR EIN 9/06, LIDOCAINE=TINNITUS 1/26/08 Nursing Allergies: PCN,PHENERGAN, TEGADERM/TAPE- ADHESIVE-BLISTERS Diet Allergies : PT DENIES ANY SEAFOOD ALLERGY Home Medication List Although John Muir Health Physicians have reviewed your Medication List, except for the specific medication changes recommended, we cannot comment or adjust medications prescribed by your Primary Care Physician or other Specialist Physician(s) . Please follow up with your Primary Care or Specialist Physician(s) , who is responsible for your general care and all other medical conditions, as well as for any continuing or long-term care. MEDICATION - Trade Name (Generic Name) DIRECTIONS DOSE ROUTE BENICAR Take NIGHTLY 20 MG BY MOUTH Next Dose Due: 01/29/08 PM CACIUM CARBONATE Take THREE TIMES A DAY 2250 MG BY MOUTH Next Dose Due: 01/29/08 8:00 PM DECIUS,ANGELA MARIE Printed: 01/29/08 at 1903 (continued) 1 'PiAHV John Muir Health John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Patient Name: ANGELA MARIE DECIUS Account #: H022159867 Birthdate: 12/28/67 Unit #: H017290 MEDICATION - Trade Name (Generic Name) DIRECTIONS DOSE ROUTE CALCITRIOL (CALCITRIOL) Take EVERY 8 HOURS 0.5 MCG BY MOUTH Next Dose Due: 01/29/08 9:00 PM COREG (CARVEDILOL) Take 2 TIMES DAILY AFTER MEALS 6.25 MG BY MOUTH Next Dose Due: 01/30/08 9:00 AM FENTANYL PATCH Take Q72HRS 100 MCG Next Dose Due: 01/30/08 AM FOLIC ACID Take DAILY 1 MG BY MOUTH Next Dose Due: 01/30/08 AM FOLIC ACID (FOLIC ACID) Take DAILY 1 MG BY MOUTH Next Dose Due: 01/30/08 9:00 AM KEPPRA Take DAILY 500 MG BY MOUTH Next Dose Due: 01/30/08 AM DECIUS,ANGELA MARIE Printed: 01/29/08 at 1903 (continued) 2 PM3MW John Muir Health John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Patient Name: ANGELA MARIE DECIUS Account #: H022159867 Birthdate: 12/28/67 Unit #: H017290 MEDICATION - Trade Name (Generic Name) DIRECTIONS DOSE ROUTE MAG-OXIDE (MAGNESIUM OXIDE) Take EVERY 12 HOURS 400 MG BY MOUTH Next Dose Due: 01/29/08 9:00 PM NORVASC Take DAILY 5 MG BY MOUTH Next Dose Due: 01/30/08 AM PLAVIX Take DAILY 75 MG BY MOUTH Next Dose Due: 01/30/08 AM PROTONIX Take DAILY 40MG BY MOUTH Next Dose Due: 01/30/08 AM SYNTHROID Take DAILY 50 MCG BY MOUTH Next Dose Due: 01/30/08 AM DECIUS,ANC;ELA MARIE Printed: 01/29/08 at 1903 (continued) 3 2M3M809 John Muir Health John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Patient Name: ANGELA MARIE DECIUS Account #: H022159867 Birthdate: 12/28/67 Unit #: H017290 Pain Medications or Medications to Take as Needed Although John Muir Health Physicians have reviewed your medication list, except for the specific medication changes recommended, we cannot comment or adjust medications prescribed by your Primary Care Physician or other Specialist Physician(s) . Please follow up with your Primary Care or Specialist Physician(s) , who is responsible for your general care and all other medical conditions, as well as for any continuing or long-term care. MEDICATION - Trade Name (Generic Name) DIRECTIONS DOSE ROUTE DILAUDID Take as needed AS NEEDED EVERY 4 HOURS 2MG BY MOUTH **THIS MEDICATION ORDER HAS BEEN CHANGED** May Take Next Dose: 8PM DECIUS,ANGELA MARIE Printed: 01/29/08 at 1903 (continued) 4 'M 3MW John Muir Health John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Patient Name: ANGELA MARIE DECIUS Account #: H022159867 Birthdate: 12/28/67 Unit #: H017290 Inpatient Discharge Intructions **Call 911 For Emergencies** **Call your physician if symptoms return or for questions and advice** Discharge Diagnosis: ESRD Appointment Comment: PAIN COTNROL BY DR. SAPHINE @ CCMC **Diet and Activity** Diet: DIABETIC RENAL **Follow Up Lab work Ordered** No follow up lab work ordered **Other Instructions** STOP Taking the Following Meds: RENAGEL & ARANESP Other Printed Instructions Provided: (Teaching Sheets, Binders or Handouts) CHF BINDER PROVIDED Your weight when you were discharged 123 .500 kg / 271 .7000 lbs Finalized By: PAP Printed By: NR-RAP DECIUS,ANGELA MARIE Printed: 01/29/08 at 1903 (continued) 5 '2'NA88V John Muir Health John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Patient Name: ANGELA MARIE DECIUS Account #: H022159867 Birthdate: 12/28/67 Unit #: H017290 Tobacco Cessation & Education Resources Stop Smoking Websites http://www.nobutts .org http://iiobutts.ucsd.edu ;especially for teens) www.quitnet.org The California Smokers' Helpline English - 1-800-NO-BUTTS Spanish - 1-800-456-6386 (NO-FUME) Mandarin & Cantonese - 1-80C-838-8917 Vietnamese - 1-800-778-8440 Korean - 1-800-556-5564 TDD/TYY - 1-800-933-4833 Chewing Tobacco - 1-800-844-2439 American Cancer Society Contra Costa Unit (925) 934-7640 1-800-227-2345 American Lung Association (925) 935-0472 Contra Costa County Health Services Health Clinics (800) 495-8885 (for Contra Costa Health Plan participants) John Muir Medical Center (925) 484-4413 Nicotine Anonymous Northern Califoria Hotline: (408) 236-2196 www.ncia-norcal .org Kaiser Permanente Diablo Service Area (fee for non-members) Antioch: (925) 813-3560 Martinez: (925) 372-1198 walnut Creek: (925) 906-2190 (925) 295-4190 Pleasanton: (925) 847-5172 Richmond: (510) 307-2210 (Rev 9/07) DECIUS,ANGELA MARIE Printed: 01/29/08 at 1903 (continued) F, '2'/i3M89' John Muir Health John Muir Medical Center - Concord Campus P.O. BOX 4110 CONCORD, CA 94524-4110 925-682-8200 Patient Name: ANGELA MARIE DECIUS Account #: H022159867 Birthdate: 12/28/67 Unit #: H017290 Infection Prevention at Home Cleaning your hands is the most important thing you can do at home to prevent infections! When should I clean my hands? * When your hands are visibly dirty. * Before you eat, and before touching your mouth, nose or eyes. * Before and after preparing food. * After contact with blood or body fluids, after using the restroom, after touching animals or pets, or after changing diapers. * Before and after touching incisions or wounds, IV's or changing dressings. Proper Handwashing: Use soap and plenty of running water if your hands are visibly soiled. * Wet hands with warm water and work soap into a lather. * Rub your hand svigorously for 15 seconds or longer. Get in between fingers and scrub wrists. * Rinse with warm running water and pat dry with clean towel. Use of Hand Sanitizers: Use hand sanitizer for routine hand cleaning only if your hands aren't visibly dirty. w Apply hand sanitizer to palm of hand. * Rub hands together until dry, making sure the sanitizer covers your entire hand and between fingers. This should take about 15 seconds. Cover your cough or sneeze * Turn away from others. * Cover your mouth or nose with a tissue, then discard in the trash. * Do not cough or sneeze into your hands. If a tissue is not available, use your upper sleeve. * Always clean your hands after coughing or sneezing. Keep Surfaces Clean Never share toothbrushes, combs, razor blades, utensils, or bath towels. If you have a fever or increased redness or drainage at a surgical or wound site, notify your physician. Infection Control Department John Muir Medical Center, Concord Campus DECIUS,ANGELA MARIE Printed: 01/29/08 at 1903 (end of report) 7 Ri3MW ***** REPORT NOT FINAL UNTIL AUTHENTICATED ***** EMERGENCY DEPARTMENT ADMIT PATIENT NAME: ANGELA M DECIUS DATE OF ADMISSION: 01/16/2008 DICTATING PHYSICIAN: Jennifer Grayzar, MD Please see template chart for full history and physical exam. EMERGENCY DEPARTMENT COURSE AND DECISION MAKING: The patient is presenting after she states that she fell out of her wheelchair and injured her bilateral lower legs. She is well known to our Emergency Department as she exhibits drug-seeking behavior on a regular basis and becomes very angry and confrontational when does not receive what she requests. Her pain management dictates that she does not receive narcotics for her chronic pain. However, she did sustain a new fall today and is having pain from this. Therefore, I have asked that the patient be given a dose of intramuscular Dilaudid and intramuscular Phenergan. She refused this and demanded to have IV narcotics. We have called the PICC line nurse and they have essentially tried to obtain IVs on this patient in the past without any significant success. I do not believe the patient needs central venous access to receive parenteral narcotic medications as we have other routes, the intermuscular route and oral route. She then began calling the PICC line nurse directly and yelling and screaming in the Emergency Department when she did not get what she wanted. I have spoken with Dr. Helms and she has authorized that the patient be allowed to have IV doses of medications. However, again I could not do that because of the aforementioned reasons. Dr. Helms has then elected to admit the patient for further workup as she also need to have dialysis today and is unable to get an appointment tomorrow. Therefore, she will complete her workup and do her dialysis here in the hospital. FINAL DIAGNOSES: 1. Status post fall out of a wheelchair with bilateral leg pain. 2. End-stage renal disease on hemodialysis. ***Edit/Authenticate Report in e-MAPS*** DD:01/16/2008 14:24 DT:01/16/2008 18:45 DOC ID: 364067 Job#: 353004 MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: ED ADMIT JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg. l 2540 East Street Concord,CA Authenticated by Jennifer A Grayzer, M.D. On 01/18/2008 04:26:41 PM Z2/13MW ***** REPORT NOT FINAL UNTIL AUTHENTICATED ***** HISTORY AND PHYSICAL PATIENT NAME: ANGELA M DECIUS DATE OF ADMISSION: 01/16/2008 DICTATING PHYSICIAN: Ileana A Helms, MD REASON FOR ADMISSION: Bilateral distal femoral fracture, pain control as well as need for dialysis secondary to fluid overload. HISTORY OF PRESENT ILLNESS: The patient is a 40-year-old lady with multiple medical problems including diabetes mellitus and hypertension for which she has been on hemodialysis for several years. The patient has secondary to noncompliance, severe secondary hyperparathyroidism which has made her bones very brittle. She presented to the Emergency Room today 01/16/08 after falling out of the wheelchair. However, the wheelchair tipped forward. She came down onto her bilateral lower legs and knee. She was seen in the Emergency Room because of pain and soreness. The x-rays were obtained and she was found to have severe bone disease secondary to hyperparathyroidism, but superimposed on acute fractures. The x-ray revealed bilateral distal femur fractures with some comminution and minimal displacement. With these findings we will control the pain today and we will ask for an orthopedic consultation today for further treatment. PAST MEDICAL HISTORY: Significant for the above problems including: 1. End-stage renal disease. 2. Hypertension. 3. Anemia. 4. Severe secondary hyperparathyroidism. 5. Severe osteoporosis. 6. Anemia. 7. Obesity. 8. Diabetes mellitus. 9. Hypertension. 10. Fluid overload. 11. Noncompliance with medications and dialysis. 12. Hypocalcemia, multifactorial including the secondary hyperparathyroidism as well as Sensipar 90 mg a day. 13. End-stage renal disease on dialysis Monday, Wednesday and Friday at the Pleasant Hill Hemodialysis Unit. 14 . Anemia, Epogen. 15. Severe triopathy including retinopathy. 16. Atherosclerotic coronary disease, status post respiratory arrest on 06/06 with elevated troponin, bradyarrhythmias which led to coronary angiography and coronary intervention as described above. 17. Goiter and hypothyroidism on replacement therapy. 18. History of bilateral peripheral neuropathy. 19. History of right foot osteomyelitis which required amputation of the right fifth toe and excision of the right metatarsal bone on 01/04. 20. History of several fractures including hips bilaterally and the left humerus. 21. History of three pregnancies with children. A 17-year-old with cerebral palsy. 22. History of chronic to mild thrombocytopenia and neutropenia has been studied by neurology in the past. MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: HP JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg. 1 2540 East Street Concord,CA ` 2MA0099 MEDICATIONS AT ADMISSION: 1. Protonix 40 mg a day. 2. Plavix 75 mg a day. 3. Norvasc 5 mg a day. 4. Keppra 500 mg a day. 5. Synthroid 50 mcg a day. 6. Benicar 20 mg a day. 7. Coreg 6.25 mg p.o. twice a day. 8. Labetalol 200 mg twice a day. 9. Folic acid 1 mg a day. 10. Tums extra strength 2 tablets in between meals and at bedtime. 11. Renagel 800 mg with meals. 12. Rocaltrol 0.5 mcg p.o. a day. 13. Levothyroxine 50 mcg p.o. a day. 14. The patient carries Dilaudid p.o. , as well as a patch for Duragesic. REVIEW OF SYSTEMS: As above. ALLERGIES: PENICILLIN, PHENERGAN and MORPHINE. PHYSICAL EXAMINATION: GENERAL: This is a 40-year-old lady. VITAL SIGNS: Temperature 98.3, pulse 103, respiration rate 19, blood pressure 177/101. 02 saturation 100% on room air. HEENT: PERRLA, EOMI. Mucosa is well hydrated. Oropharynx within normal limits. NECK: Supple, no jugulovenous distention, ho lymphadenopathy, no thyromegaly. LOWER EXTREMITIES: She has significant deformities bilaterally in the lower extremities and significant pain on both knees. She also has significant deformities in the ankles. There is no tenderness in the hip area. There were no abrasions. LABORATORY DATA: At admission, sodium 127 and potassium 3.5, total CO2 22, BUN 44, creatinine 5. 65. WBC 9.1, hemoglobin 11. 9, hematocrit 33.4 with platelets 142,000. IMPRESSION AND PLAN: This is a patient with bilateral distal femur fractures that will require an orthopedic consult and pain management. She was having chills on dialysis. We will give her vancomycin and aztreonam. Will check levels tomorrow. The patient will have dialysis in the morning and surgery in the afternoon. We will continue with the rest of the medications and readjust the insulin. ***Edit/Authenticate Report in e-MAPS*** DD:01/17/2008 18:26 DT:01/17/2008 19:26 DOC ID: 364973 Job#: 353914 MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: HP JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.2 2540 East Street Concord,CA Authenticated by Ileana A Helms MD On 01/20/2008 03:05:14 PM 2M3 889 9 ***** REPORT NOT FINAL UNTIL AUTHENTICATED ***** ORTHOPEDIC CONSULTATION PATIENT NAME: ANGELA M DECIUS DATE OF CONSULTATION: 01/17/2008 DICTATING PHYSICIAN: Christopher J Coufal, MD REFERRING PHYSICIAN: Ileana Helms, M.D. REASON FOR CONSULTATION: Evaluation of bilateral distal femur fractures. HISTORY OF PRESENT ILLNESS: The patient is a 40-year-old female with multiple medical problems which are significant for end-stage renal disease and secondary severe hyperparathyroidism. She presented to the Emergency Room yesterday after falling out of wheelchair. Her wheelchair tipped forward and she came down onto her bilateral lower legs and knee. She was seen in the Emergency Room and was having pain and soreness. X-rays were obtained which found her to have severe bone disease secondary parathyroidism but superimposed on acute fractures today. X-rays revealed bilateral distal femur fractures with some comminution and minimal displacement. With these findings, orthopedic consultation was obtained for further evaluation and treatment. PAST MEDICAL HISTORY: Significant for the above-mentioned disorders. Again, she has got end-stage renal disease and is on chronic hemodialysis 3 times a week. The patient is well known to Dr. Helms. She has got ongoing and chronic anemia secondary to renal disease as well. PAST SURGICAL HISTORY: She has had chronic pain secondary to her multiple destroyed joints secondary to hyperparathyroidism. She has essentially previous fractures which have gone on to have essentially reabsorption in her hips and ankles. She is nonambulatory and gets around in a motorized wheelchair. ALLERGIES: The patient has allergies to PHENERGAN and PENICILLIN. CURRENT MEDICATIONS: Include Prilosec, Renagel, Benicar, Dilaudid, folic acid, Coreg and Plavix. PHYSICAL EXAMINATION: GENERAL: Today shows a 40-year-old female who looks older than stated age. EXTREMITIES: She has got significant deformities in bilateral lower extremities and significant pain in bilateral knees today. She has got deformities in her feet secondary to her previous fractures and deformities in her hips and ankles. She has got generalized tenderness and soreness in the area of the fractures and pain with any motion. There is no tenderness over the hip regions. There are no abrasions over the knees at this time. DIAGNOSTIC DATA: X-rays for evaluation include multiple x-rays of the bilateral lower extremities. These x-rays reveal severe secondary hyperparathyroidism with osteopenic changes and chronic joint changes. The patient essentially has no hip joints bilaterally with probably previous hip fractures and reabsorption of the fracture site. The distal femurs are still intact and there is evidence of bilateral distal femur fractures with minimal displacement. The knee joints are still present. Severe osteopenic changes within the tibias bilaterally and at the level of the ankles severe MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: CONSULTATION JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg. 1 2540 East Street Concord,CA 2MM8899 deformities and complete absence of the ankle joint and distal tibia distal fibulas. These are all chronic changes from her bone disease. ASSESSMENT AND PLAN: The patient is a 40-year-old female with end-stage renal disease on hemodialysis and has severe hyperparathyroidism secondary to her renal disease. She sustained a fall on her wheelchair and has acute bilateral distal femur fractures. In light of her medical condition, I still feel that it would be beneficial to undergo surgical treatment and stabilization of her bilateral femur fractures with percutaneous plating of the femurs. This allowed significant improvement in pain control and stabilized these fractures. Otherwise, she has gone on to have severe reabsorption of these fracture sites. Luckily the patient is being planned for a parathyroid removal over at UCSF and this will help decrease some of the reabsorption at the fracture site. Surgical previous procedures have been discussed with the patient and she is going to think about it. I would like to proceed here in the near future. Her case has been discussed with the primary care doctor, Dr. Helms, who will help get her prepared for surgical treatment. ***Edit/Authenticate Report in e-MAPS*** DD: 01/17/2008 14:14 DT:01/17/2008 15:01 DOC ID: 364732 Job#: 353670 cc: Ileana Helms MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: CONSULTATION JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.2 2540 East Street Concord,CA Authenticated by Christopher J Coufal, M.D. On 01/17/2008 03:30:43 PM 2M3/ 880' ***** REPORT NOT FINAL UNTIL AUTHENTICATED ***** INFECTIOUS DISEASE CONSULTATION PATIENT NAME: ANGELA M DECIUS DATE OF CONSULTATION: 01/20/2008 DICTATING PHYSICIAN: Dr. Nimisha Mishra, MD REQUEST PHYSICIAN: Dr. Ileana Helms. REASON FOR CONSULTATION: This consultation is requested for fever and symptoms of ringing in the ear by the patient. HISTORY OF PRESENT ILLNESS: The patient is a 40-year-old female who has a history of diabetes, end-stage renal disease on hemodialysis and hyperparathyroidism with multiple fractures in the past. She was admitted on 01/16 status post fall from her wheelchair which resulted in bilateral supracondylar fractures and required open reduction internal fixation by Dr. Coufal on 01/18. The surgery went okay. The patient received 1 gram of vancomycin on 01/16 and probably some more on the day of surgery, 400 grams on the day of surgery. Per the op notes, the patient received 2 grams of kanamycin, although this is not very clear. The patient was doing okay. On 01/18, she had a low-grade temperature of 100.8. On 01/19, she had a temperature of 102.1 and on 01/2, she had a T-max of 101 degrees. The patient denies feeling hot, although she says that she does feel chilly and cold at times. Says that she was having some nausea and an episode of vomiting prior to admission. She is currently having some loose stools. She says that she also has some cough which is mostly dry but sometimes she can bring up some thick sputum. PHYSICAL EXAMINATION: VITAL SIGNS: The patient is seen in dialysis and her T-max today is 101. T-current 100.1, pulse 102, respirations of 18, blood pressure of 83/49. GENERAL: The patient is currently in dialysis and complaining of feeling cold. She is an obese lady who is in no apparent distress. HEENT. Moist mucous membranes. Pupils equally round and reacting to light. No lymphadenopathy. LUNGS: Clear to auscultation anteriorly, although the exam is very limited secondary to her body habitus. HEART: S1, S2 is heard, no murmurs. ABDOMEN: Positive bowel sounds, soft, nontender. EXTREMITIES: The patient has Ace bandages over her bilateral thighs going up to the upper mid calf, secondary to her surgery and does not want any further examination at this time. She has a right upper extremity AV fistula from which she is getting dialyzed and she is also getting a unit of blood. PAST MEDICAL HISTORY: Her other past medical history is significant for diabetes with retinopathy, status post laser surgery, peripheral neuropathy, Charcot ankles bilaterally, hyperparathyroidism with multiple fractures in the past, wheelchair bound, end-stage renal disease on hemodialysis, hypertension, anemia, hypothyroidism and a history of multiple admissions for infections. The patient is very noncompliant. Her past history of infection include a right IJ catheter septicemia because of staph aureus in 2002, right thigh and calf cellulitis secondary to group A strep in 2003, right fifth toe with gangrene change in 01/2004, right calf abscess secondary to serratia in 08/2004, right heel ulcers with E. coli in 06/2005 and group B strep septicemia in 12/2005 requiring the long duration of vancomycin. Also history of cocaine abuse in the past. ALLERGIES: Has a history of allergy to PENICILLIN which causes hives, MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: CONSULTATION JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg. 1 2540 East Street Concord,CA although has received cephalosporins with no problem. According to the patient and old records, she is also allergic to MORPHINE and PHENERGAN. SOCIAL HISTORY: Lives at home with her family husband and 2 children, 17 and 15-year-old. History of cocaine abuse in the past. MEDICATIONS ON ADMISSION: Include 1. Protonix. 2. Plavix. 3. Norvasc. 4. Keppra. S. Synthroid. 6. Benicar. 7. Coreg. 8. Labetolol. 9. Folic Acid. 10. Tums. 11. Renagel. 12. Rocaltrol. 13. Levothyroxine. 14. Dilaudid. LABORATORY DATA: Blood cultures from the 01/16 and 01/19, 2 sets each are negative. Her white count is 6.3, hemoglobin 8.8, hematocrit 26.1, platelets of 104. Chem-7 is significant for hyponatremia. Sodium 126, potassium 5.8, chloride 95, bicarbonate 22, BUN 39, creatinine 5. 9. The patient, of note, has a vancomycin trough of 8.4 drawn today at 7:10 in the morning. This is not likely to cause the patient's symptoms of tinnitus. The patient has received 2 doses aztreonam, also 1 gram daily since yesterday. IMPRESSION: 1. Fever and chills in the patient of questionable etiology. Need to work it up. The patient is postop day #2 status post open reduction internal fixation of bilateral supracondylar femur fractures. Could be postop fever and to rule out other sources also bloodstream infections, soft tissue infection, C. diff or pneumonia. 2. Tinnitus. All medications are being evaluated, could be secondary to the kanamycin that the patient received or the lidocaine patch. Vancomycin trough at the level of 8.4 is highly unlikely cause of causing this. Aztreonam is not known to cause tinnitus. 3. Diabetes with retinopathy, neuropathy and Charcotjoint. 4. Hyperparathyroidism with brittle bone and multiple fractures. 5. End-stage renal disease on hemodialysis via right AV fistula. 6. Hypothyroidism. 7. PENICILLIN allergy, cephalosporins are okay. 8. History of noncompliance. 9. History of multiple infections in the past. PLAN: 1. Check a serum kanamycin level. 2. Sputum culture. 3. Check stool for C. difficile 4. Chest x-ray to evaluate for any infiltrates. 5. Will discussed with ortho about the surgical site and have the wounds look. 6. Will give the patient one dose of vancomycin today 400 mg IV and Levofloxacin 500 IV q.48 pending cultures. Thank you for letting me participate in the care of Mrs. Decius. MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: CONSULTATION JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.2 2540 East Street Concord,CA 2MM8899 ***Edit/Authenticate Report in e-MAPS*** DD:01/20/2008 17:27 DT:01/20/2008 18:24 DOC ID: 366474 Job#: 355415 cc: Ileana Helms MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: CONSULTATION JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.3 2540 East Street Concord,CA Authenticated and Edited by Nimisha Mishra, M.D. On 1/29/08 4:34:48 PM Ri3MW ***** REPORT NOT FINAL UNTIL AUTHENTICATED ***** OPERATIVE REPORT PATIENT NAME: ANGELA M DECIUS DATE OF SURGERY: 01/18/2008 DICTATING PHYSICIAN: Christopher J Coufal, MD PREOPERATIVE DIAGNOSES: 1. Right distal femur fracture, AO type A2. 2. Left distal femur fracture, AO type Al. POSTOPERATIVE DIAGNOSES: 1. Right distal femur fracture, AO type A2. 2. Left distal femur fracture, AO type Al. PROCEDURES PERFORMED: 1. Open reduction internal fixation of the right distal femur fracture. Right distal femur fracture using the Synthes LISS system. 2. Open reduction internal fixation of the left distal femur fracture using the Synthes LISS system. SURGEON: Christopher J Coufal, MD ASSISTANT SURGEON: None. ANESTHESIA: General endotracheal. ANESTHESIOLOGIST: Joshua Meezan, MD ESTIMATED BLOOD LOSS: 150 mL. FLUIDS RETURNED: 350 mL of crystalloid. COMPLICATIONS: None. SPECIMENS: None. DRAINS: None. OPERATIVE INDICATIONS: The patient, Angela Decius, is a 40-year-old female who has had significant medical problems, which include end-stage renal disease, and she is on chronic hemodialysis 3 times a week. She also is afflicted with severe secondary hyperparathyroidism. With this, she has significant bony abnormalities of her skeleton and joints and, however, sustained a fall out of her wheelchair when going down a curb and ended up falling forward, sustaining closed bilateral distal femur fractures. The patient was admitted to the hospital by the Nephrology Service and now comes to the operating room at this time for surgical stabilization of her bilateral distal femur fractures. OPERATIVE PROCEDURE IN DETAIL: On 01/18/2008, after appropriate preoperative laboratories were checked and surgical consent was signed, the patient was taken to the operating room and placed upon the Jackson table in supine position. Once the patient was transferred, she then underwent induction of general endotracheal anesthesia. Once appropriate anesthesia was on board, the patient was given vancomycin for preoperative antibiotic prophylaxis. At MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: OPERATIVE REPORT JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.l 2540 East Street Concord,CA /13/�OO�g this point, the bilateral lower extremities to the hip regions were prepped and draped in normal sterile fashion using DuraPrep solution. The procedure was commenced on the right lower extremity. The right lower extremity was positioned over a small triangle. This was used to bring the fracture out to length as well as reduce the pull of the muscles on the distal femur. Under direct fluoroscopy, the fracture was able to be brought out to length. Green towels were built up underneath the level of the distal femur and the knee posteriorly to help decrease some of the extension deformity at the level of the fracture. Longitudinal traction under fluoroscopy was used to bring the fracture out easily out to length. With fluoroscopy complete, an approximately 2-inch lateral incision was made over the lateral femoral condyle. Incision was taken down through the subcutaneous tissues and through the iliotibial band, which was split in line with the fibers. This gave access to the lateral femoral condyle down to the level of the joint. Through this, also, the plate could be slid up into the vastus lateralis. Under fluoroscopic imaging, a 9-hole plate was felt to be adequate for fixation of this distal femur fracture. A 9-hole LISS plate was placed on the external guide and then placed percutaneously underneath the vastus and onto the lateral aspect of the distal femur. Care was taken to center the plate as well as possible on the distal femur. Under fluoroscopy, temporary guide pins were placed to hold the plate in position on the distal femur. Again, longitudinal traction was used to help reduce the fracture, and the plate was then pinned with the unicortical pin to maintain the overall length. At this point, intraoperative x-rays again were obtained. AP and lateral views showed the plate to be in good position. It was quite difficult to see the bone due to its severe osteopenic nature. It was quite soft during the procedure as well, and the K-wires were easily pushed into the bone, and no real drilling was needed. At this point, with the plate in good position, multiple locking, fully-threaded locking screws were passed through the distal femur and spread out to the distal femur to give good purchase onto the distal femur. Following this, further fixation, distal or proximal to the fracture was undertaken. The push-pull reduction device was placed at the level of the fracture to suck the plate down onto the lateral aspect of the femur. Once this was done, a total of three 40-mm bicortical locking screws were placed with a single unicortical screw at the top end of the plate. At this point, internal fixation was complete, and the external guide was removed. Final fluoroscopic views were obtained under fluoroscopy, and AP and lateral views were sent to the PAC system. With completion of internal fixation, the patient underwent closure of the right leg. No tourniquet was used, and the wounds were thoroughly irrigated with antibiotic solution. In closure, the 0 Vicryl suture was used to reapproximate the vastus fascia in a figure-of-eight fashion. Following this, subcutaneous tissues were closed with 0 and 2-0 Vicryl sutures, and then the skin was closed with staples. With the right leg complete, our attention was taken to the left leg. In similar fashion, the left leg was bent over a small positioning triangle. Under fluoroscopy, this fracture was much less displaced than the right side. It was easily maintained anatomic reduction. With this in similar fashion, a 2-inch incision was made over the lateral aspect of the lateral femoral condyle. Incision was taken down through the subcutaneous tissues through the IT band and then down to the lateral aspect of the femur. Again, a 9-hole LISS plate was placed percutaneously and fit nicely onto the lateral aspect of the lateral femoral condyle. This underwent temporary K-wire fixation and was checked under fluoroscopy to be in good position. Following pinning, the patient underwent fixation distally with multiple locking screws in the distal end of the plate, followed by a combination of locking and nonlocking screws MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: OPERATIVE REPORT JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.2 2540 East Street Concord,CA 2/23 8899 proximal to the fracture. Once all the screws were placed, final fluoroscopic views were obtained and sent to the PAC system. The patient had anatomic alignment of the fracture on the left leg. With these findings, internal fixation was complete and closure was commenced. Closure consisted of thorough irrigation of the left knee wound with antibiotic solution. Hemostasis was achieved with electrocautery. The vastus fascia was closed with multiple 0 Vicryl sutures in a figure-of-eight fashion, following with closure of subcutaneous tissues using 0 and 2-0 Vicryl sutures and eventual closure with staples. Again, at least at this point, dressings were placed on both legs, which consisted of Xeroform 4 x 4s, coverall and Ace wraps to hold the bandages in place. With this, the procedures on both legs were complete. The patient was subsequently brought up from general anesthesia. She was subsequently extubated in the operating room and then sent to the recovery room in stable condition. ***Edit/Authenticate Report in e-MAPS*** DD: 01/21/2008 01:14 DT:01/21/2008 07:40 DOC ID: 366635 Job#: 355579 MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: OPERATIVE REPORT JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.3 2540 East Street Concord,CA Authenticated by Christopher J Coufal, M.D. On 01/23/2008 02:40:42 PM RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 1 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC PATIENT: DECIUS,ANGELA MARIE REG DATE: 01/16/08 LOC : B5 UNIT #: H017290 ACCT # H022159867 DIS DATE: 01/29/08 ROOM: 5206 KAISER #: REG DR : HELMS, ILEANA A. STATUS : DIS IN BED : 1 AGE/SEX : 40/F DOB : 12/28/67 H=HIGH L=LOW *H,*L=CRITICAL HA **=ABN ##### HEMATOLOGY ##### Date 01/29/08 01/28/08 01/27/08 01/26/08 Time 0620 0645 0845 1055 Reference Units WBC 3.4 L 3.9 L 5.6 3.9 L (5.0-10.0) K/CMM RBC 3 .4 L 3.2 L 3 .4 L I 3.1 L (4 .2-5.4) M/CMM HGB 11.2 L 10.4 L 10.5 L 9.8 L (12.0-16 .0) GM/DL HCT 32.3 L 30.1 L 32 .2 L 28.6 L (37.0-47.0) t MCV 94 94 94 94 (80-100) FL MCHC 35 34 33 34 (31-35) g/dL RDW I 15.0 I 15.6 H 15.1 15.3 H (10.5-15.1) o PLTA 189 192 194 163 (150-400) K/CMM #NEUT 1.8 2.6 3 .3 2.2 (1.7-8.2) K/CMM #LYM 1.2 I 1.0 1 .8 1.3 (0.7-5.0) K/CMM #MON 0.2 0.2 0.3 0.2 (0.1-1.6) K/CMM #EOS 0.1 0.1 0.2 0.1 (0.0-1.0) K/CMM #BASO 0.0 0.0 0.0 0.0 (0.0-0.4) K/CMM NEUT 53 65 59 58 (34-82) t %LYM 36 25 32 33 (15-50) %MON 7 5 6 6 (3-16) °s ItEOS 4 3 4 3 (0-9) BASO 1 1 1 1 (0-4) Date 01/25/08 01/24/08 01/23/08 01/21/08 Time 0845 0710 0700 0530 Reference Units WBC 3.9 Lj 3.5 L 3 .9 L 4.1 L (5.0-10.0) K/CMM RBC 3 .0 L I 3.0 L 2 ,9 L I 2.6 L (4 .2-5.4) M/CMM HGB 9.6 L 9.6 L 9.4 L 8.5 L (12.0-16.0) GM/DL HCT 27.7 L 28.0 L 27.1 L 24.0 L (37.0-47.0) t MCV 93 94 93 94 (80-100) FL MCHC 35 34 3536 H {31-35) g/dL RDW 15.2 H I 15.1 15.1 15.3 H (10.5-15.1) % PLTA 159 154 127 L 86 L (150-400) K/CMM #NEUT 2.5 2.2 2.7 2.7 (1.7-8.2) K/CMM #LYM I 1 .1 0.9 0.9 1.0 (0.7-5.0) K/CMM #MON 0.2 0.2 0.2 0.3 (0.1-1.6) K/CMM #EOS 0.1 0.1 0.1 0.0 (0.0-1.0) K/CMM #BASO 0.0 0.0 0.0 0.0 (0.0-0.4) K/CMM °s NEUT 64 64 68 67 (34-82) g %LYM 27 27 11 24 25 (15-50) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 2 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### HBKATOLOGY ##### Date 01/25/08 01/24/08 01/23/08 01/21/08 Time 0845 0710 0700 0530 Reference Units %MON 5 6 5 7 (3-16) % %EOS 3 3 3 1 (0-9) % ?.BASO 0 1 1 0 (0-4) % Date --------01/20/08-------- 01/19/08 01/18/08 Time 0853 0710 0730 2055 Reference Units WBC 6.3 (a) 7.1 6.5 (5.0-10.0) K/CMM RBC 2 .7 L NGT DONE 2 .8 L I 2.9 L (4 .2-5.4) M/CMM HGB 8.8 L NOT DONE 9.2 L 9.3 L (12.0-16.0) GM/DL HCT 26.1 L NOT DONE 26 .4 L 27.5 L (37.0-47.0) % MCV 96 NOT DONE 95 95 (80-100) FL MCHC 34 INOT DONE 35 34 (31-35) g/dL RDW 14 .7 INOT DONE 14 .4 1 14 .8 (10.5-15.1) % PLTA 104 L NOT DONE 97 L 106 L (150-400) K/CMM #NEUT 1 4.1 INOT DONE 4.7 5.3 (1.7-8.2) K/CMM #LYM I 1.6 INOT DONE 1 .6 1 0.7 (0.7-5.0) K/CMM #MON 0.4 INOT DONE 0.6 0.6 (0.1-1.6) K/CMM #EOS 0.1 INOT DONE 0.1 0.0 (0.0-1.0) K/CMM #BASO 0.0 INOT DONE 0.0 0.0 (0.0-0.4) K/CMM $NEUT 1 66 INOT DONE 66 80 (34-82) % %LYM I 26 INOT DONE 23 I 10 L (15-50) % %MON 7 INOT DONE 9 9 (3-16) % %EOS 2 INOT DONE 2 1 (0-9) % %BASO 0 INOT DONE 1 1 0 (0-4) Date 01/18/08 01/17/08 01/16/08 Time 0725 0610 1405 Reference Units WBC 5.5 6.5 9.1 (5.0-10.0) K/CMM RBC 3 .0 L I 3.3 L 3 .6 L I I (4 .2-5.4) M/CMM HGB 9.8 L 10.9 L 11.9 L (12.0-16.0) GM/DL HCT 28 .1 L 31.9 L 33.4 L (37.0-47.0) % MCV 95 96 94 (80-100) FL NOTES: (a) NOT DONE SPECIMEN CLOTTED, TEST RESULTS WOULD NOT BE ACCURATE; SPECIMEN DISCARDED. JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 3 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### HEMATOLOGY ##### Date 01/18/08 01/17/08 01/16/08 Time 0725 C610 1405 Reference Units MCHC 35 34 36 H (31-35) g/dL RDW 14.8 15.1 14 .3 (10.5-15.1) k PLTA 101 L 126 L 145 L (150-400) K/CMM #NEUT 3.5 4.5 7.5 (1.7-8.2) K/CMM #LYM I 1 .3 1 .4 1 .0 I (0.7-5.0) K/CMM #MON 0.4 0.6 0.5 (0.1-1.6) K/CMM #ECS 0.2 0.0 0.1 I (0.0-1.0) K/CMM #BASO 0.0 0.0 0.0 (0.0-0.4) K/CMM %,NEUT 64 68 82 (34-82) %; %LYM 24 22 11 L I (15-50) !k MON 8 9 6 (3-16) SECS 3 0 1 (0-9) w %BASO 0 1 0 (0-4) w MISCELLANEOUS HEM Date 01/28/08 01/27/08 01/24/08 01/23/08 Time 0645 0845 0710 0700 Reference Units WESR 66 H (b) 78 H 79 H (0-21) MM/HR Date 01/21/08 Time 0530 Reference Units WESR 83 H I I (0-21) MM/HR NOTES: (b) NOT DONE QUANTITY NOT SUFFICIENT TO PERFORM TEST. JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC g h 53 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 4 RUN TIME: 0216 Discharge Summary Report RUN USER; DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB 12/28/67 ##### CHEMISTRIES ##### ELECTROLYTES Date 01/29/08 01/28/08 01/27/08 01/26/08 Time 0620 0645 0845 1055 Reference Units NA 127 L 127 L 132 L 132 L (135-145) mmol/L K 4.3 5.5 H 4.6 4.0 (3.5-5.1) mmol/L CL 102 98 98 99 (95-110) mmol/L TCO2 24 20 L 24 23 (22-32) mmol/L ANION GAP 1 L 9 10 (7-16) mmol/L Date 01/25/08 01/24/08 01/23/08 01/21/08 Time 0845 0710 0700 0530 Reference Units NA 128 L 132 L 124 (c) L 129 L (135-145) mmol/L K 3 .7 3.8 3 .9 3.7 (3 .5-5.1) mmol/L CL 96 100 101 98 (95-110) mmol/L TCO2 22 23 22 24 (22-32) mmol/L ANION GAP 10 9 7 (7-16) mmol/L Date 01/20/08 01/19/08 --------01/18/08-------- Time 0710 0730 2055 0725 Reference Units NA 126 L 128 L 129 L 127 L (135-145) mmol/L K 5.8 (d) H I 4.1 4 .3 4 .4 (3 .5-5.1) mmol/L CL 95 99 98 98 (95-110) mmol/L TCO2 22 25 23 24 (22-32) mmol/L bate 01/17/08 01/16/08 Time 0610 1405 Reference Units NA 132 L 127 L (135-145) mmol/L K 3.7 3.5 (3.5-5.1) mmol/L CL 102 96 (95-110) mmol/L NOTES: (c) CLIN SIG ABN PHONED to: B5, J BIGELOW, RN Read Back Performed? YES By: LB-ERL on 01/23/08 at 1037 (d) CLIN SIG ABN PHONED to: B5, J.BIGELOW, RN Read Back Performed? YES By: 102755 on 01/20/08 at 1013 JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 5 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 bat#: H017290 (Continued) DOB : 12/28/67 ##### CHEMISTRIES ##### ELECTROLYTES Date 01/17/08 01/16/08 Time 0610 1405 Reference Units TCO2 25 22 (22-32) mmol/L CHEM-GENERAL Date 01/29/08 01/28/08 01/27/08 01/26/08 Time 0620 0645 0845 1055 Reference Units MAGNESIUM 2.2 1.5 L 1.5 L (1.6-2.6) mg/dL BUN 22 33 H 23 12 (5-26) mg/dL CREATININE 4.00 H 5.36 H 4.48 H 3.27 H (0.50-1.30) mg/dL eGFR NON AF-AMI (e) I (f) (g) (h) eGFR AFR-AMER (i) (k) (1) (m) CALCIUM 8.2 L 6 .2 L 6.9 L (8.6-10.5) mg/dL PHOSPHORUS 4 .7 6 .0 H 3.8 (2 .4-4 .7) mg/dL NOTES: (e) 13 mL/min/1.73m2 (f) 10 mL/min/1.73m2 (g) 12 mL/min/1.73m2 (h) 16 mL/min/1.73m2 (i) 16 mL/min/1.73m2 See also (j) (j) Stages of Chronic Kidney Disease Stage Description Estimated GFR (mL/min/1.73m2) 1 Normal or Increased GFR >89 2 Mild decrease 60-89 3 Moderate decrease 30-59 4 Severe decrease 15-29 5 Kidney Failure <15 (k) 11 mL/min/1.73m2 See also (j) (1) 14 mL/min/1.73m2 See also (j) (m) 20 mL/min/1.73m2 See also (j) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC gg hh A885533 �/199 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 6 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 blR#: H017290 (Continued) DOB 12/28/67 ##### CHEMISTRIES ##### CHEM-GENERAL Date 01/25/08 01/24/08 01/23/08 01/21/08 Time 0845 0710 0700 0530 Reference Units MAGNESIUM 1.7 1.8 1 .8 (1.6-2.6) mg/dL BUN 27 H 18 32 H 26 (5-26) mg/dL CREATININE 4.57 H 3.34 H 4.80 H (0.50-1.30) mg/dL eGFR NON AF-AMI (n) I (0) (p) eGFR AFR-AMER I (q) I (s) (t) CALCIUM 7.9 L 8.3 L (8.6-10.5) mg/dL PHOSPHORUS 2.4 1 .7 L 1 2.4 (2 .4-4 .7) mg/dL Date 01/20/08 01/19/08 --------01/18/08-------- Time 0710 0730 2055 C-725 Reference Units MAGNESIUM 1.9 1.7 2.1 (1.6-2.6) mg/dL BUN 39 H 24 17 32 H (5-26) mg/dL CREATININE 5.90 H 4 .26 H 3.54 H 4.97 H (0.50-1.30) mg/dL eGFR NON AF-AMI (u) I (v) (w) I (x) NOTES: (n) 11 mL/min/1.73m2 (o) 16 mL/min/1.73m2 (p) 10 mL/min/1.73m2 (q) 13 mL/min/1.73m2 See also (r) (r) Stages of Chronic Kidney Disease Stage Description Estimated GFR (mL/min/1 .73m2) 1 Normal or Increased GFR >89 2 Mild decrease 60-89 3 Moderate decrease 30-59 4 Severe decrease 15-29 5 Kidney Failure <15 (s) 19 mL/min/1 .73m2 See also (r) (t) 13 mL/min/1.73m2 See also (r) (u) 8 mL/min/1.73m2 (v) 13 mL/min/1.73m2 (w) 15 mL/min/1.73m2 (x) 10 mL/min/1.73m2 JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC . 2M3/L0009 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 7 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### CHEMISTRIES ##### CHEM-GENERAL Date 01/20/08 01/19/08 --------01/18/08-------- Time 0710 0730 2055 0725 Reference Units -eGFR APR-AMER (y) (aa) (ab) (ac) CALCIUM 7.1 L 7.2 L 7.2 L (8.6-10.5) mg/dL PHOSPHORUS 2.6 2 .2 L 3.3 (2.4-4.7) mg/dL Date --------01/17/08-------- 01/16/08 Time 2000 0610 1405 Reference Units MAGNESIUM 2.2 2 .1 (1.6-2 .6) mg/dL BUN 20 44 H (5-26) mg/dL CREATININE 3.61 H 5.65 H (0.50-1.30) mg/dL eGFR NON AF-AMI (ad) (ae) eGFR AFR-AMER I (af) (ag) CALCIUM 1 7.7 L 7.9 L (8 .6-10.5) mg/dL PHOSPHORUS 11 2.2 L 1.6 L 1.8 L (2.4-4.7) mg/dL NOTES: (y) 10 mL/min/1.73m2 See also (z) (z) Stages of Chronic Kidney Disease Stage Description Estimated GFR (mL/min/1.73m2) 1 Normal or Increased GFR X89 2 Mild decrease 60-89 3 Moderate decrease 30-59 4 Severe decrease 15-29 5 Kidney Failure <15 (aa) 15 mL/min/1.73m2 See also (z) (ab) 19 mL/min/1.73m2 See also (z) (ac) 13 mL/min/1.73m2 See also (z) (ad) 15 mL/min/1.73m2 (ae) 9 mL/min/1.73m2 (af) 18 mL/min/1.73m2 See also (z) (ag) 10 mL/min/1.73m2 See also (z) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC 2p/13M899 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 8 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOH 12/28/67 ##### CHEMISTRIES ##### LIVER STUDIES Date 01/26/08 01/23/08 01/17/08 01/16/08 Time 1055 0700 0610 1405 Reference Units ALBUMIN 2.7 L 2.7 L 3 .3 L 3.6 (3.4-5.0) g/dL THYROID Date 01/26/08 Time 1055 Reference Units TSHU ULTRA SEN11 0.31 L 1 (0.34-3.50) uIU/mL GLUCOSE TESTS Date ---------------------01/29/08--------------------- Time 1703 1146 0735 0325 Reference Units GLUC 213 (ah) H 186 (ak) H I 124 (al) 201 (am) H j (50-130) mg/dL Date ---------------------01/28/08--------------------- Time 2056 1715 1131 0756 Reference Units GLUC 149 (an) H 212 (ao) H 191(ap) H 120(aq) (50-130) mg/dL NOTES: (ah) See (ai) , (*aj) (ai) POINT OF CARE TEST (*aj) Point of Care Testing (ak) Comments: Pre Meal See also (ai) , (*aj) (al) See (ai) , (*aj) (am) See (ai) , (*aj) (an) See (ai) , (*aj) (ao) Comments: Pre Meal See also (ai) , (*aj) (ap) See (ai) , (*aj) (aq) Comments: Pre Meal See also (ai) , (*aj) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 9 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### CHEMISTRIES ##### GLUCOSE TESTS Date 01/28/08 ---------------01/27/08--------------- Time 0645 2031 1724 1146 Reference Units GLUC 213 (ar) H 144 (au) H 139 (av) H (50-130) mg/dL GLUCOSE CASUAL11 100 (aw) I 1 1 (50-130) mg/dL Date --------01/27/08-------- --------01/26/08-------- Time 0757 0309 2057 1728 Reference Units GLUC 158 {ax) H 177 (ay) H 179(az) H 139 (ba) H (50-130) mg/dL Date ---------------01/26/08--------------- 01/25/08 Time 1153 0741 0326 2038 Reference Units GLUC 212 (bb) H 1140 (bc) H 229(bd) H 1287 (be) H 1 (50-130) mg/dL NOTES: (ar) Comments: Post Meal See also (as) , (*at) (as) POINT OF CARE TEST (*at) PoiIlt of Care Testing (au) Comments: Pre Meal See also (as) , (*at) (av) Comments: Pre Meal See also (as) , (*at) (aw) Glucose >200 mg/dL plus symptoms of Diabetes = Diabetes. (ax) Comments: Pre Meal See also (as) , (*at) (ay) Comments: Nocturnal See also (as) , (*at) (az) See (as) , (*at) (ba) Comments: Pre Meal See also (as) , (*at) (bb) Comments: Pre Meal See also (as) , (*at) (bc) See (as) , (*at) (bd) Comments: Received Meds See also (as) , (*at) (be) Comments: Post Meal See also (as) , (*at) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 10 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 bM#: H017290 (Continued) DOB 12/28/67 ##### CHEMISTRIES ##### GLUCOSE TESTS Date ---------------------01/25/08--------------------- Time 1723 1150 0845 0752 Reference Units GLUC 225 (bf) H 231 (bi) H 154 (bj) H (50-130) mg/dL GLUCOSE CASUAL 1 11 143 (bk) H 1 (50-130) mg/dL Date 01/25/08 ---------------01/24/08--------------- Time 0259 2122 1739 1121 Reference Units GLUC 219 (bl) H 245 (bm) H 241(bn) H 1180 (bo) H (50-130) mg/dL Date --------01/24/08-------- --------01/23/08-------- Time 0739 0316 2027 1733 Reference Units GLUC 134 (bp) H 1135 (bq) H 246 (br) H 1390 (bs) H 1 (50-130) mg/dL NOTES: (bf) Comments: Pre Meal See also (bg) , (*bh) (bg) POINT OF CARE TEST (*bh) Point of Care Testing (bi) See (bg) , (*bh) (bj) Comments: Pre Meal See also (bg) , (*bh) (bk) Glucose >200 mg/dL plus symptoms of Diabetes = Diabetes. (bl) See (bg) , (*bh) (bm) See (bg) , (*bh) (bn) See (bg) , (*bh) (bo) Comments: Pre Meal See also (bg) , (*bh) (bp) Comments: Pre Meal See also (bg) , (*bh) (bq) See (bg) , (*bh) (br) Comments: Post Meal See also (bg) , (*bh) (bs) Comments: Pre Meal See also (bg) , (*bh) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 11 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB 12/28/67 ##### CHEMISTRIES ##### GLUCOSE TESTS Date ---------------------01/23/08--------------------- Time 1146 0700 0658 0253 Reference Units GLUC 226 (bt) H 179(bw) H 1199 (bx) H (50-130) mg/dL GLUCOSE CASUALS 1149 (b ) H I 1 (50-130) mg/dL Date ---------------------01/22/08--------------------- Time 2148 1738 1147 0747 Reference Units GLUC 178 (bz) H 191 (ca) H 173 (cb) H 1194 (cc) H (50-130) mg/dL Date 01/22/08 ---------------01/21/08--------------- Time 0303 2049 1713 1129 Reference Units GLUC 172(cd) H 1203 (ce) H 365(cf) H 1188 (cg) H (50-130) mg/dL NOTES: (bt) See (bu) , (*bv) (bu) POINT OF CARE TEST (*bv) Point of Care Testing (bw) See (bu) , (*bv) (bx) See (bu) , (*bv) (by) Glucose >200 mg/dL plus symptoms of Diabetes = Diabetes. (bz) See (bu) , (*bv) (ca) See (bu) , (*bv) (cb) Comments: Pre Meal See also (bu) , (*bv) (cc) See (bu) , (*bv) (cd) See (bu) , (*bv) (ce) See (bu) , (*bv) (cf) Comments: Pre Meal See also (bu) , (*bv) (cg) Comments: Pre Meal See also (bu) , (*bv) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC P/1A8809 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 12 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### CHEMISTRIES ##### GLUCOSE TESTS Date --------01/21/08-------- --------01/20/08-------- Time 0738 0345 2139 1738 Reference Units GLUC 242 (ch) H 198 (ck) H 226 (cl) H 1224 (cm) H (50-130) mg/dL Date ---------------------01/20/08----------- ---- Time 1125 0743 0710 0303 Reference Units GLUC 336 (cn) H 1215 (co) H I I 241 (cp) H (50-130) mg/dL GLUCOSE CASUAL I IF18-5(cq) H (50-130) mg/dL Date ---------------------01/19/08--------------------- Time 2114 1730 1127 0809 Reference Units GLUC 271 (cr) H 1247 (cs) H 254 (ct) H 1209 (cu) H 1 (50-130) mg/dL NOTES: (ch) Comments: Pre Meal See also (ci) , (*cj) (ci) POINT OF CARE TEST (*cj) Point of Care Testing (ck) See (ci) , (*cj) (cl) Comments: Post Meal See also (ci) , (*cj) (cm) Comments: Pre Meal See also (ci) , (*cj) (cn) Comments: Pre Meal See also (ci) , (*cj) (co) See (ci) , (*cj) (cp) Comments: Nocturnal See also (ci) , (*cj) (cq) Glucose >200 mg/dL plus symptoms of Diabetes = Diabetes. (cr) See (ci) , (*cj) (cs) See (ci) , (*cj) (ct) Comments: Pre Meal See also (ci) , (*cj) (cu) See (ci) , (*cj) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 13 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB 12/28/67 ##### CHEMISTRIES ##### GLUCOSE TESTS Date --------01/19/08-------- --------01/18/08-------- Time 0730 0335 2257 2135 Reference Units GLUC 180 (cv) H 440(cy) H 418 (cz) H (50-130) mg/dL GLUCOSE CASUAL11 170 (da) H 1 (50-130) mg/dL Date ---------------------01/18/08--------------------- Time 2055 1710 1127 0725 Reference Units GLUC I 244 (db) H 222 (dc) H I (50-130) mg/dL GLUCOSE CASUAL -353 (da) H 1238 (da) H (50-130) mg/dL Date --------01/18/08-------- --------01/17/08-------- Time 0617 0305 2101 1657 Reference Units GLUC 279 (dd) H 313 (de) H 11 183 (df) H 1248 (dg) H (50-130) mg/dL NOTES: (cv) See (cw) , (*cx) (cw) POINT OF CARE TEST (*cx) Point of Care Testing (cy) See (cw) , (*cx) (cz) Comments: Post Meal See also (cw) , (*cx) (da) Glucose >200 mg/dL plus symptoms of Diabetes = Diabetes. (db) See (cw) , (*cx) (dc) Comments: Pre Meal See also (cw) , (*cx) (dd) See (cw) , (*cx) (de) See (cw) , (*cx) (df) See (cw) , (*cx) (dg) Comments: Pre Meal See also (cw) , (*cx) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 14 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### CHEMISTRIES ##### GLUCOSE TESTS Date ---------------------01/17/08--------------------- Time 1127 0813 0610 0331 Reference Units GLUC 265 (dh) H 183 (dk) H 284 (dl) H (50-130) mg/dL GLUCOSE CASUALS 11 150(dm) H (50-130) mg/dL Date ---------------------01/16/08--------------------- Time 2115 2101 2059 1947 Reference Units GLUC I (dn) *H (do) *H 1395 (dp) H (50-130) mg/dL GLUCOSE CASUAL 441 (dm) H I 1 (50-130) mg/dL Date --------01/16/08-------- Time 1405 1109 Reference Units GLUC I 276 (dq) H 1 (50-130) mg/dL GLUCOSE CASUAL 206 (dm) H I 1 (50-130) mg/dL NOTES: (dh) See (di) , (*dj) (di) POINT OF CARE TEST (*dj) Point of Care Testing (dk) See (di) , (*dj) (dl) Comments: Received Meds See also (di) , (*dj) (dm) Glucose >200 mg/dL plus symptoms of Diabetes = Diabetes. (dn) > 499 *H Alert Value greater than 499 See also (di) , (*dj) (do) > 499 *H Alert Value greater than 499 See also (di) , (*dj) (dp) See (di) , (*dj) (dq) See (di) , (*dj) JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 15 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB : 12/28/67 ##### CHEMISTRIES ##### CHEM MISCELLANEOUS Date 01/18/08 Time 0725 Reference Units GLYCATED HGB 6.6 H ( (4.5-6.1) t HBA1C Date 01/22/08 01/20/08 01/18/08 Time 0725 0710 0725 Reference Units TIME FROM DOSE11 UNKNOWN UNKNOWN UNKNOWN HOURS VANCO TROUGH 11 5.4 (dr) 8 .4 (dr) 12.9(dr) (5.0-20.0) ug/mL ##### LAB MISC. TESTS ##### ENDOCRINE Date 01/24/08 Time 0710 Reference Units CALCIUM 17.3 (*ds) L 1 I (8.4-10.2) mg/dL NOTES: (dr) Falsely low results may occur in this Vancomycin assay due to interference by abnormal immunoglobulins in patients with plasma cell dyscrasias and lympoid malignancies. In this event, samples should be run by an alternate method. (*ds)ARUP Laboratories, 500 Chipeta way Salt Lake City, Utah 84108 JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC gg 55 �/iM8899 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 16 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-C10C Patient: DECIUS,ANGELA MARIE #H022159867 bat#: H017290 (Continued) DOB 12/28/67 ##### LAB MISC. TESTS ##### ENDOCRINE Date 01/24/08 Time 0710 Reference Units INTACT PTH 284 (dt) H (15-75) pg/mL NOTES: (dt) ------------------------------------------ P -+-------+-------+-------+--------+P 400 + . . . . . . S P. . . . . + T + . . . . . . .S P. . . . . .+ H 284 ------<*>. . . S P. . . . . .P+ + ! . S P. . . . . .P + I 200 +. ! S P. . . . . P + N + ! . S P . . . . P + T 100 +. ! S P . . . . P + A + ! . S P. . . .P + C 75 +S S S '. S S-S-S---------PP . P + T + ! + P.P + 50 + ! + NORMAL + + p + ! + Ca/PTH + + g 30 + ! + + + / +H H H ! H H ------M M M M M M M M + m 10 +. ! H H M . . . . . . . + L + ! . H M . . . . . . .+ +. ! H M . . . . . . . + 0 ++---/--+-------+-------+-------+---/---++ 4 8 9 10 11 15 Total Calcium (mg/dL) Box = Reference Interval <*> = Patient Result P = Primary Hyperparathyroidism S = Secondary Hyperparathyroidism H = Hypoparathyroidism M = Hypercalcemia of Malignancy See also (*du) (*duiARUP Laboratories, 500 Chipeta Way Salt Lake City, Utah 84108 JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 17 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB 12/28/67 ##### LAB MISC. TESTS ##### MISCELLANEOUS TESTS Date 01/29/08 Time 0620 Reference Units PREALBUMIN 12.3 L (18.0-38.0) mg/dL JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC �/�3'7�OOt39 RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 18 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB 12/28/67 Microbiology Specimen Summary Col Date Time Specimen # Source So Desc P F Organisms . > 01/24/08 0930 08 :P0000290R STOOL F CTOX NEC > 01/19/08 1640 08 :BC0000617S BLD VEN F <none> > 01/19/08 1630 08 :BC0000616S BLD VEN F <none> > 01/16/08 1805 08 :BC0000499S BLOOD FIST F <none> > 01/16/08 1750 08:BC0000498S BLOOD FIST F <none> BACTERIOLOGY Source: BLOOD VENOUS Collection Date: 01/19/08 > BLOOD CULTURE Final 01/25/08 NO GROWTH AT 5 DAYS > BLOOD CULTURE Preliminary (changed) NO GROWTH AT 2 DAYS > BLOOD CULTURE Final 01/25/08 NO GROWTH AT 5 DAYS > BLOOD CULTURE Preliminary (changed) NO GROWTH AT 2 DAYS Source: BLOOD FISTULA Collection Date: 01/16/08 > BLOOD CULTURE Final 01/22/08 NO GROWTH AT 5 DAYS > BLOOD CULTURE Preliminary (changed) NO GROWTH AT 2 DAYS > BLOOD CULTURE Final 01/22/08 NO GROWTH AT 5 DAYS > BLOOD CULTURE Preliminary (changed) NO GROWTH AT 2 DAYS JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC RUN DATE: 01/31/08 MT. DIABLO *LIVE NPR* LAB SYSTEM PAGE 19 RUN TIME: 0216 Discharge Summary Report RUN USER: DP-COC Patient: DECIUS,ANGELA MARIE #H022159867 MR#: H017290 (Continued) DOB 12/28/67 FECAL STUDIES Source: STOOL Collection Date: 01/24/08 > C DIFFICILE TOXIN Final 01/24/08 C DIFFICILE TOXIN - NEGATIVE Trans Date Product Unit # Status Volume Bld Type Comp? 01/21/08 LP RBC 84K98383 PRSMD TRFSD 350 CC 0 NEG Y 01/20/08 LP RBC 84KM76965 PRSMD TRFSD 350 CC 0 NE„ Y TYPE AND SCREEN STUDIES COLLECTED: Jan 20, 2008 8:53am > ABO/RH TYPE 0 NEG > ABSC INTERP. NONE DETEC CROSSMATCH REQUESTS COLLECTED: Jan 20, 2008 8 :53am XM PC 84KM76965 LP RBC 0 NEG Comp? Y PC 84K98383 LP RBC 0 NEG Comp? Y Cancelled List 0118:C00150S CAN, Coll: 01/18/08-0700 Recd: - (R#02906472) HELMS,ILEANA A. ordered: CA Comment: ADDLAB 0127:H00121R CAN, Coll: 01/27/08-0932 Recd: - (R#02915543) HELMS, ILEANA A. Ordered: WESR Comment: OREDER FOR 01/28/08 PER RN JOHN MUIR MEDICAL CENTER PATHOLOGISTS: Concord Campus D. BEERLINE, M.D. , INC 2540 East Street, Concord, CA 94520-1960 C. CESCA, M.D. P. 0. Box 4110, Concord, CA 94524-4110 B. P. LATNER, M.D. , INC (925) 674-2184 N. SHIHABI, M.D. , INC l2/iM0099 EXAMS 000994350 FEMUR RT 73550 Complete right femur series (73550) : 1/16/08 at 1357 hours History: Leg injury (959.7) . Leg pain (729.5) . Comparison: None. Findings: An acute comminuted nondisplaced nonangulated supracondylar fracture of the distal right femur is present. Femoral arterial calcification is present. Impression: Acute nondisplaced comminuted supracondylar fractures of the distal right femur are present. Released By: - DAVID WIXSON, MD Original Dictation Dt:01/16/2008 Transcribed Dt:01/16/2008 1502 PAGE 1 Signed Report Name DECIUS, ANGELA Acct No H022159867 Ordering Md GRAYZAR, JENNIFER A. DOB 12/28/1967 MR# H017290 JOHN MUIR MEDICAL CENTER CONCORD CAMPUS DIAGNOSTIC IMAGING 2540 EAST ST CONCORD, CA 94520 (925) 682-8200 l 'MM8899 EXAMS 000994351 TIBIA + FIBULA RT 73590 Complete right tibia and fibula series (73590) : 1/16/2008 at 1352 hours. History: Leg injury (959.7) . Pain (729.5) . Comparison: None. Findings: I am presented these exams on 1/21/2008 as no prior dictation can be located. There is no evidence of acute right tibial or fibular fracture or subluxation. There is long-standing deformity of the distal right tibia and fibula and proximal right foot,with tapering of the distal right tibia and fibula and severe right tibiotalar and subtalar joint space narrowing. Surgical clips and possible varicosities overlie the soft tissues of the right calf. Impression: No evidence of acute tibial or fibular fracture. *** REPORT SIGNATURE ON FILE *** SIGNED BY: WIXSON,DAVID MD Released By: - DAVID WIXSON, MD Original Dictation Dt:01/21/2008 Transcribed Dt:01/21/2008 1146 PAGE 1 Signed Report Name DECIUS, ANGELA Acct No H022159867 Ordering Md GRAYZAR, JENNIFER A. DOB 12/28/1967 MR# H017290 JOHN MUIR MEDICAL CENTER CONCORD CAMPUS DIAGNOSTIC IMAGING 2540 EAST ST CONCORD, CA 94520 (925) 682-8200 g h 5 2p iM8899 EXAMS 000994352 TIBIA + FIBULA LT 73590 Complete left tibia and fibula series (73590) : 1/21/08 at 1354 hours. Clinical History: Injury, pain. Comparison: None. Findings: Examinations were performed on 1/16/08 but no dictations can be found. I was asked to read the exams on 1/21/08. Findings: There is no evidence of acute fracture or subluxation. Osteopenia. There is tapering of the distal right tibia and fibula. Arterial calcifications within the calf. Diffuse right calf soft tissue calcifications possibly representing varicosities. Impression: No evidence of acute left tibial or fibular fractures. *** REPORT SIGNATURE ON FILE *** SIGNED BY: WIXSON,DAVID MD Released By: - DAVID WIXSON, MD Original Dictation Dt:01/21/2008 Transcribed Dt:01/21/2008 1147 PAGE 1 Signed Report Name DECIUS, ANGELA Acct No H022159867 Ordering Md GRAYZAR, JENNIFER A. DOB 12/28/1967 MR# H017290 JOHN MUIR MEDICAL CENTER CONCORD CAMPUS DIAGNOSTIC IMAGING 2540 EAST ST CONCORD, CA 94520 (925) 682-8200 � g h M85 �/189 9 EXAMS 000995213 KNEE LIMITED LT 73560 Limited left knee series (73560) : 1/18/08 at 1454 hours. Clinical History: Supracondylar fracture distal left femur 1/16/08. Comparison: Left knee radiographs 1/16/08. Findings: The patient is immediately status post ORIF. Lateral cortical plate middle and distal third left femur with right angle threaded screws traversing the supracondylar fracture site. Distal screws terminate within the supracondylar left femur. No evidence of significant displacement or angulation at the fracture site. Impression: The patient is status post ORIF supracondylar fracture distal left femur as detailed above. There is no evidence of appreciable angulation or displacement status post ORIF. *** REPORT SIGNATURE ON FILE *** SIGNED BY: WIXSON,DAVID MD Released By: - DAVID WIXSON, MD Original Dictation Dt:01/18/2008 Transcribed Dt:01/18/2008 1558 PAGE 1 Signed Report Name DECIUS, ANGELA Acct No H022159867 Ordering Md COUFAL, CHRISTOPHER DOB 12/28/1967 MR# H017290 JOHN MUIR MEDICAL CENTER CONCORD CAMPUS DIAGNOSTIC IMAGING 2540 EAST ST CONCORD, CA 94520 (925) 682-8200 Ri3MW EXAMS 000995214 KNEE LIMITED RT 73560 Limited intraoperative right knee series (73560) : 1/18/08. Clinical History: Acute supracondylar distal right femoral fracture on 1/16/08. Comparison: 1/16/08. Findings: Interval ORIF with vertically oriented plate paralleling the lateral cortex of the mid and distal right femur containing multiple right angle threaded screws (both cephalad and caudal to the fracture site) . Distal right femur is anterior to the proximal right femur at the fracture site. Impression: Intraoperative ORIF acute supracondylar fracture distal right femur as detailed above. *** REPORT SIGNATURE ON FILE *** SIGNED BY: WIXSON,DAVID MD Released By: - DAVID WIXSON, MD Original Dictation Dt:01/18/2008 Transcribed Dt:01/18/2008 1558 PAGE 1 Signed Report Name DECIUS, ANGELA Acct No H022159867 Ordering Md COUFAL, CHRISTOPHER DOB 12/28/1967 MR# H017290 JOHN MUIR MEDICAL CENTER CONCORD CAMPUS DIAGNOSTIC IMAGING 2540 EAST ST CONCORD, CA 94520 (925) 682-8200 •� • 2M3M099 EXAMS 000995659 CHEST PA/LAT 71020 Chest two views (71020) : 1/21/2008 at 1357 hours. History: Fever (780.6) . Comparison: 1/4/2008. Findings: Morbid obesity with poor inspiration. Unchanged mild prominence of the cardiac-pericardial silhouette and central pulmonary veins. No evidence of focal pulmonary infiltrate. Unchanged very minimal right basilar pleural disease. Impression: No change from 1/4/2008 as detailed above. *** REPORT SIGNATURE ON FILE *** SIGNED BY: WIXSON,DAVID MD Released By: - DAVID WIXSON, MD Original Dictation Dt:01/21/2008 Transcribed Dt:01/21/2008 1452 PAGE 1 Signed Report Name DECIUS, ANGELA Acct No H022159867 Ordering Md MISHRA, NIMISHA MD DOB 12/28/1967 MR# H017290 JOHN MUIR MEDICAL CENTER CONCORD CAMPUS DIAGNOSTIC IMAGING 2540 EAST ST CONCORD, CA 94520 (925) 682-8200 Oakland Office Law Offices of San Francisco Office 1300 Clayland,C 940 O'Donnell & Smith 54r PacFrancisco, CA941 venue Oakland,CA 94612 San Francisco,CA 94133 Tel(510)986-1065 309 Lennon Lane, #101 Tel 14151984-0161 Email:oandslawOool.com Walnut Creek, CA 94598 Email:oandslaw@aol.com Tel (925) 935-1707 Fax (925) 935-9625 website: www.oandslaw.com February 29, 2008 VIA OVERNITE EXPRESS Angela Decius 285 Kathleen Drive Pleasant Hill, CA 94523 Re: Possible Personal Injury Claim Dear Ms. Decius: You contacted our office to ascertain whether we would be interested in representing you in a possible personal injury claim arising out of a fall that took place in Pacheco on January 16, 2008.After discussing this matter with you and after considering the circumstances of your case, we have decided not to undertake this case on your behalf. Our decision is based on a number of practical considerations, medical facts and circumstances. Our decision not to undertake your representation is based primarily upon the number of cases, such as yours, which we can effectively and efficiently handle, and the difficulty of this type of case given the present state of the law, rather than upon the merits of your claim. Please understand that while we decline to undertake your representation,this in no way limits your right to seek other legal advice if you so desire. Our decision to decline representation is based, in part, upon practical considerations and another attorney may evaluate this case differently. If you decide that you wish to pursue this matter further, you should know that there are certain time periods within which you must do certain things in a personal injury action or forever lose your rights. The calculation of these time periods can be difficult. Personal injury claims against a governmental entity must be brought within six months of the date of the accident. Consequently, if you are going to have another attorney look at this matter,you should do so as soon as you can. If you are unable to find a lawyer on your own,you might try the Bar Association of San Francisco Lawyer Referral Service(telephone 415 989-1616)or the Contra Costa County Bar Association Referral Service(telephone 925 686-6900). I would like to thank you for contacting our office, and I am sorry that we could not be of any further assistance to you in this matter. Accompanying this letter please find the medical records you kindly provided for our review and some information we obtained concerning Invacare. Should you have any questions, please do not hesitate to call. Very trul you , James J. 4DJnell, Esq. O'Donnell & Smith w/encls. i ,�07-7(38 Ge a `C U �� ?�1 f —Ok' •�� / G c- y� Zfr31�� JOHN MUIR H E A L T H John Muir Medical Center Concord Campus '.2540 East Street Concord, r'A 94520 T.(925)682-8200 RE-DISCLOSURE STATEMENT THE INFORMATION THAT HAS BEEN PROVIDED TO YOU IS CONFIDENTIAL AND ONLY FOR THE PERSON TO WHOM IT IS ADDRESSED. YOU MAY NOT MAKE ANY FURTHER RE- DISCLOSURES OF THIS INFORMATION WITHOUT A WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS, OR AS OTHERWISE PERMITTED BY APPLICABLE STATE LAW. IF THESE RECORDS INCLUDE INFORMATION WHICH IS PROTECTED BY FEDERAL REGULATIONS (42 C.F.R. PART 2 OR CALIFORNIA WELFARE & INSTITUTIONS CODE 5328), A GENERAL AUTHORIZATION IS NOT SUFFICIENT FOR THIS PURPOSE. g 3 *****REPORT NOT FINAL UNTIL AUTHENTICATEDk-"" DISCHARGE SUMMARY PATIENT NAME: ANGELA M DECIUS DATE OF ADMISSION: 01/16/2008 DATE OF DISCHARGE: 01/29/2008 DICTATING PHYSICIAN: Ileana A Helms, MD REASON FOR ADMISSION: Mechanical fall, bilateral knee fractures. HISTORY OF PRESENT ILLNESS: Mrs. Decius fell on the street and on top of her was her mechanical wheelchair. The patient developed a right distal and left distal femur fractures, for which she underwent, on 01/18/2008, open reduction and internal fixation of the right distal femur fracture using the Synthes system and also and open reduction internal fixation of the left distal femur fracture using the Synthes LISS system. The patient had severe pain, but after the surgery it improved somewhat. The patient required a pain management as well as some physical therapy while she was here. At the time of discharge, she was doing much better, able to at least move in bed. Dr. Saffier at the Contra Costa Medical Center will continue taking care of her medical management. The patient refers she feels somewhat better. She had a fever during this admission, and Dr. Mishra consulted on the case for Infectious Disease. She was current on antibiotics, but after all the blood cultures were negative, it was decided that probably it was postop fever. The patient is going home without any major complications. DISCHARGE DIAGNOSES: 1. Bilateral distal femur fractures, bilateral ORIF by Dr. Coufal. 2. History of fluid overload in multiple locations. 3. History of severe hyperparathyroidism despite Sensipar. Now, the patient is more compliant on phosphorus. The patient will have a parathyroidectomy at UCSF in around 3 weeks. 4. End-stage renal disease, on hemodialysis 3 times a week. 5. Diabetes mellitus, stable. 6. Secondary hyperparathyroidism secondary to noncompliance. 7. Anemia, on Epogen. 8. Hypertension, stable. 9. Severe triopathy including retinopathy. 10. Atherosclerotic coronary artery disease. 11. Status post respiratory arrest in 06/2006 with elevated troponin and bradyarrhythmias, which lead to coronary angiography and coronary intervention as described in previous H&Ps. 12. Goiter and hypothyroidism, on replacement therapy. 13. History of bilateral peripheral neuropathy. 14 . History of right foot osteomyelitis with resultant amputation of the right fifth toe, excision of the right metatarsal bone in 01/2004 . 15. History of several fractures in both legs and left upper extremity secondary to severe hyperparathyroidism and some of them secondary to trauma including an accident in her wheelchair and scooter. 16. Past history of a saphenous vein graft to the left arm for dialysis access with the veins harvested from the right leg. 17. Status post left AV fistula and retrieval of it secondary to sepsis. 18. Peripheral vascular disease. 19. History of anemia, group B strep in 12/2005. 20. E. coli sepsis in 06/2005. 21. History of chronic mild thrombocytopenia and neutropenia that has been MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: DISCHARGE SUM JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg. 1 2540 East Street Concord,CA studied by hematology and oncology. 22. History of diastolic dysfunction with some diastolic dysfunction and ejection fraction of 59%. 23. Past history of bilateral hip fractures. MEDICATIONS AT DISCHARGE: 1. Protonix 40 mg a day. 2. Plavix 75 mg a day. 3. Amlodipine 5 mg a day. 4. Keppra 500 mg a day. 5. Synthroid 50 mcg a day. 6. Benicar 20 mg a day. 7. Coreg 6.25 mg twice a day. 8. Labetalol 200 mg twice a day. 9. Folic acid 1 mg a day. 10. Tums Extra Strength 2 tablets in between meals and at bedtime. 11. Renagel 800 mg 2 tablets with meals. 12. Rocaltrol 0.5 mcg p.o. a day. 13. Levothyroxine 50 mcg p.o. a day. 14 . The patient carries Dilaudid as well as a Catapres and Duragesic patch given at the Contra Costa Medical Center. ALLERGIES: PENICILLIN, PHENERGAN and MORPHINE. COMPLICATIONS: None. DIET: Renal ADA, 2 grams potassium, 1.5 liters fluid restriction. The patient has been instructed to follow the diet, the fluid restriction and to go to her dialysis unit. The patient again will be contacted by UCSF in 3 weeks for a parathyroidectomy. ***Edit/Authenticate Report in e-MAPS*** DD: 02/14/2008 12: 16 DT:02/14/2008 12:56 DOC ID: 381987 Job#: 370973 cc: Dialysis Center Pleasant Hill Kenneth Saffier MR#:H017290 Acct:H022159867 Name:DECIUS, ANGELA M Report: DISCHARGE SUM JOHN MUIR MEDICAL CENTER CONCORD CAMPUS pg.2 2540 East Street Concord,CA MEMORANDUM TO FILE FROM JJO DATE CASE RE There is no "City of Pacheco". It's part of the County and the only thing I could find was the following information about the town council. There is no address or phone number. Only a "contact us" form you can fill out online and send them to get information. www.j2achecotowncouncil.com Pacheco Town Council The Pacheco Town Council was formed to advance the welfare of the properties located in the area commonly known and designated as Pacheco,County of Contra Costa, State of California, and in particular to preserve the established character of Pacheco as a residential and industrial district,to endorse and activate movements to continually improve the area, including, without limitation,the development of roads, schools, sanitary conditions, utility services,the establishment, ownership and operation of community facilities for community use, and to participate in all matters, activities and proceedings pertaining directly or indirectly to the welfare of the area,and any action, governmental or otherwise, effecting the area in any manner. In general,to do all things and exercise any and all powers which it may now or hereafter be lawful for the corporation to do or exercise under the laws of the State of California that may now or hereafter be applicable to this corporation. This association does not contemplate pecuniary gain or profit to members thereof. Governing Board Executive Board President Keith March Vice President Doug Stewart Secretary/Treasurer Sally Norgaard Building Manager Kay Perry-Thayer Board Members Brian March Sharon Schutjer I t Ing;acare Corporation - About Us Page 1 of 1 About Invacare Invacare Corporation is the world's leading manufacturer and distributor in the$8.0 billion worldwide market for medical equipment used in the home. The company designs, manufactures, and distributes an extensive line of health care products for the non-acute care environment, including the home health care, retail, and extended care markets. When the company was acquired in December 1979 by Mal Mixon and a small group of investors, it had $19.5 million in net sales and a limited product line of standard wheelchairs and - patient aids. Today, Invacare has reached approximately $1.5 billion in net sales and is the leading company in each of the following major, - non-acute, medical equipment categories: power and manual wheelchairs, home care bed systems, and home oxygen systems. Invacare is the only company in the home medical equipment industry with a full line of products: • Rehab Products Custom power and custom manual wheelchairs, seating and positioning, and scooters. • Respiratory Products Oxygen systems, sleep, and nebulizers. • Standard Products Bath safety, walkers, wheelchairs, beds, and therapeutic support surfaces. The company sells its products to over 25,000 home health care and medical equipment providers, distributors, and government locations in the United States, Australia, Canada, Europe, New Zealand, and Asia. The company has 5,700 associates and markets its products in 80 countries around the world. Invacare stock is traded on the New York Stock Exchange under the symbol IVC. I If z d / � h rd/inv com an /com an info js ?s=0&area=Mai... 2/7/2008 http://www.invacare.com/cgi-bin/im qp _ p y p y_ p Invacare Product Catalog - Pronto M71 with SureStep Page 1 of 2 AMM Affirm 7; Yes, you Can. User Name: Password: " Login Help Other Invacart You are here: Home/Product Catalog/Wheelchairs and Top End/Power Wheelchairs/ Series/Non Powered Seating% Products Pronto M71 with a Product Literature Search SureStep SureStep technology for • � • r w smooth driving Fl! New Zone Product ID: M71 Bariatric Products HCPCS Code: K0821— HMESA CODE:20-10-03-03 Starting A Beds and Bed-Related Product Description Products The Invacare Pronto M71 power wheelchair with SureStep off( Lifts and Slings maneuverability and true-mid-wheel-drive performance in a co Power Operated Vehicles design. With its innovative SureStep technology, the M71 driv( over transitions and thresholds up to two inches while maitaini Respiratory Another key feature of the M71 is its ability to be disassemble( Seating and Positioning for easy transport. With the Pronto M71, consumers can mane Self-Care and Patient Aids and around the home and take it with them wherever they go. Click image for larger view technology provides optimum traction and stability as the Pron Sleep over transitions and thresholds of up to 2 inches or negotiates terrain. The high torque of the motors lifts the front casters to Therapeutic Support , • changes in height for a smooth, less jarring ride over rough su Surfaces SureStep technology allows six wheels to remain in contact wi Uni-Reclinersto maximize performance, improve stability and enhance comf List Price Sheet(s) controllable power chair. Wheelchairs and Top End • Pronto M71 with... Glossy Sell Sheet ♦ Features Owner's Manual • SureStep technology allows for smooth driving over threshc transitions up to two inches View Parts • Compact size and true-mid-wheel drive for the tightest turni Product Comparison possible Email This Product • 6 wheels on the ground provide optimum stability Print This Page • Disassembles without the use of tools for easy transport Additional Documents • Semi-recline van seats and flip-up adjustable-height and wi — added comfort 0 Specifications Turning Radius: 19.5"overall turning radius Electronic Options: MK5 NX (full programmability) Speed: Maximum of 4.25 mph Charger: 3 amp (on-board) Product Weight Capacity: 300-Ib. user weight capacity http://www.invacare.com/cgi-bin/imhgprd/inv_catalog/prod_cat_detail.j sp?s=0&prodID=M... 2/7/2008 Ir Invacare Product Catalog - Pronto M71 with SureStep Page 2 of 2 Incline Capability: 9 degrees Product Weight: Van seat assembly: 46 Ib Batte assembly: 25 Ib each Battery ti assembly: 21 Ib Side frame as: Ib each Footboard & mounting Warranty: New limited warranty for chairs or after March 1, 2007: Non-Transferable Base Frame:5 years Seat Frame: 3 years Electrical Components: 1 year Motors: 1 year Batteries: 6 months Remaining components(excep upholstered materials, padded tires/wheels): 1 year NOTE: For more detail please refer to the full specifications brochure lir call Customer Service at(800)333-6900.All specifications, prices,and configurations are subject to change without notification.Accessories ai products shown in the photographs are not necessarily included in the I wheelchair. Please refer to current price lists located at www.invacare.c Related Products Pronto M91 with SureStep-The new and improved Pronto M91 now feature Traction (TCD)for improved weight distribution and performance, and Stability Lock for enhance transitions... more MSRP Price-Manufacturing Suggested Retail Price does not include optional equipment and accesso available for this product. **This information is not intended to be, nor should it be considered billing or legal advice. Providers are determining the appropriate billing codes when submitting claims to the Medicare Program and should c attorney or other advisor to discuss specific situations in further detail. Documents are available for download in PDF format. About,Us I Product Catalog I Ask-Invacare Career Center I Investor Relations Site Map I Sports&Recreation Policy& Funding I International I Privacy_Policy. Invacare Supply I Long Term Carel Invac..are Home Copyright@ 2008 Invacare Corporation.All rights reserved.Trademark Ownership Nom. For the best possible experience,Invacare recommends using Internet Explorer 6.0 to view the website. http://www.invacare.com/cgi-bin/imhgprd/inv_catalog/prod_cat_detail.j sp?s=0&prodID=M... 2/7/2008 • Invacare Corporation - Product Recall Page 1 of 1 Medical Device Field Correction -June 2005 Invacare Pronto Series Power Wheelchairs Posted June 24, 2005 A field correction is being conducted for Invacare's Pronto Series power wheelchairs, Models M50, M51 and M61 that have office style arms. These devices were distributed between January 20, 2005 — March 15, 2005. There is a possibility that if the arm of the wheelchair is overloaded, the joystick mounting bracket (see A on Figure 1) and/or the arm pivot (see B on Figure 1) may fail. This failure may cause the user or a caregiver to fall if leaning on the arm, and could result in injury. Though no injuries have been reported yet, Invacare feels that addressing this issue now will prevent problems in the future. • � - B A Figure 1 To determine if your Pronto series wheelchair is involved in the corrective action, check the serial number label on the product. The impacted serial number range is from 05Axxx (January 2005) thru and including 05Cxxx (March 2005). The replacement of the arms is to be completed promptly. Please contact your Invacare provider to schedule the installation of the replacement arms. Additional questions can be directed to: Invacare's Customer Relationship Management Group Email: CRMGroup@lnvacare.com Fax: 877-619-7996 Phone: 800-347-5440, ext. 2000 Mail: Larry Smith Invacare Corporation, One Invacare Way, Elyria, OH 44036-2125 http://www.invacare.com/cgi-bin/imhgprd/inv_productalert/prod_alert.j sp?s=0&WT.svl=to... 2/7/2008