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HomeMy WebLinkAboutMINUTES - 01062009 - C.13 (9) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 06, 2009 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 on your claim by the Board of ��Q v Supervisors. (Paragraph IV below), given Pursuant to Government Code AMOUNT: DEC 0 4 2008 Section 913 and 915.4. Please note all COU $30,000.00 . `Warnings", COUNTY CALIF.COUNSEL CLAIMANT: CHRISTIAN McCO 1 ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 04, 2008 ADDRESS: 320 HAWK RIDGE DRIVE BY DELIVERY TO CLERK ON; DECEMBER 04, 2008 RICHMOND, CA 94806 RECEIVED FROM RISK BY MAIL POSTMARKED: MANAGEMENT FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DAVID TWA, Cler Dated: DECEMBER 04, 2008 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Sup6rvisori (vYThis claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). O Other: Dated: Z ` �' By: Deputy County Counsel III. 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.JIOARD ORDER: By unanimous vote of the Supervisors present: (►y' 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. DatMVID TWA, CLERK, By; e B9.Zw Deputy Clerk WARNING(CA. 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 court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in.connection with this matter.If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This 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 I 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. Dated. AVID TWA, CLERK, By ��/ ` IIeputy Clerk This warning does not �,P„_ply to claims which are not subject bklien,C�lifornia Tort Claims Act such as actions in iMrse condemnation', actions for specific relief suefi as mandamus or junction, or Federal Civil Rights claims. The alcove list is not exhaustive and-legal consultation is essential tdbaderstapd;-all the . t t ry r� .. separate limitations periods`tliat•niay.'apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your.particular claim. The County of Contra Costa does not waive any of� ts;rights under California Tort Claims Act does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act 4 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 6S ` -INTSTRUCTIONS 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 fled 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 fled against each. public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. [■■■2111111111111 ovum man axon■■■i■■[■[[[■[[![[![t[[[[[![[ [[f[[![[![[!tl[[l![[!![[!ERE MR Claim By: Reserved for Clerk's filing stamp C Coy ) D PanhY r9ail0 . a Against the County of Contra Costa or ) CL Df Q 2008 DEC 0'2 2008 RKgCq,���� District) CoNTRAi, "/lsoRs (Fill in the name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$2 and in support of this claim represents as follows: 1. When did the dama e or injury occur? (Give exact date and hour) s C1 I s t orb c0'. 3o Fnn 2. Where did the damage or injury occur? (Include city and county) Pdl rhm A , Cavrtr& 005-t7A COO r+✓l 3. H��oyyw�� did the ddapmaagge�• or injury occur? (Give full details;use extra paper /cif rre�quiired) /L wAvko svfFOLA A,'1n`10�04S V1 hack �'�L1v�tS�° c(�' �Ia`�,/v7m W Sln u,. 4. at partic ar act or omissio on the part of county or district officers, servants, oremployees caused the injury or damage? -Jv�%s cae, vi�y vyn C&V- wbu v► ,�Q Inad a ! �� . 5 What are the names of county or district officers, servants, or employees causing the damage or injury? cMkcQo-1-MV 6 w 6. damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the es aced amount of any prospective injury or damage.) S. Names and addresses of witnesses, doctors, and hospitals: ft 6v Qv �✓� �; ��Inm 1 9. List the expenditures you made on account of this accident or injury: DATE TDAE AMOUNT A 11Alte cv 30pf' * 12AC1 Reason a N a s s a a a s E KKR a NIKKO ata Egan a a E a a N N E E a N a E N a a a a a E N a a N a a a E N a a E N E a W E a a all a a N a E N a s a a N l .Gov. Code Sec. 910.2 provides "The claim shall be ) signed b claimant or by s son on his )b SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) Ilk i is 32- a,w�- N���- (Address)) 4 f O� Telephone No. ) Telephone No. ■W a N E a a l a N a N l W E a a E N a a t E a i am a W a!E N a E E E a N t a!E N a E s a N a a a N no N N a N N W E N a E a E f E a a s a Kong KIM a a E t i 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 at seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. s ■KKR■aEaaaOsaa■ago a NEWS a ■aat■NaEEaNa■■EEaaeO■aaaaaaasasun■a ENaaEE■aa Ea E■ ■■a ONES■sa El 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 ($10,000), or by both such imprisonment and fine. CONSENT TO RELEASE MEDICAL INFORMATION I, rs-E1 to N'-6vuv authorize d 1� ,� P (Name of Patient) (Provider of Health Care) to disclose to the bearer, who represents the County of Contra Costa—Risk Management Division and/or designated copy service, all medical information to substantiate a claim initiated by me. I hereby consent and request that the bearer be permitted to examine and obtain copies of all hospital and medical records of every sort and kind, interview doctors and other attendants regarding all matters relating to examination, diagnosis, care and treatment of myself. I understand that this Consent for the Release of Medical Information will remain valid cancelled by me. I hereby acknowledge that I have received a copy of this Consent for Release of Medical Information. It is understood that a Photostat of this autho ' a 'o is as v li a original. Date: . ( D Signed: Address: �ZbAWI 01 , � 6n �OCp (Conservator or Guardian) Date of Birth: ( 210 a Z$ Social Security No. 511 3��� KAISER PERMANENTE Kaiser Permanente KP ALAMEDA WCR DISCHARGE PHARMACY, IST FL Transaction ResultS__. merch ID; 445020900820 Merchant# 600516001 status: approved Trans 0 025-0012594855 Date: 15SepO8 Time: 9:37pm TransaCtion Details Date: 10-06-2008 14:03 PDT Cashier: U568394 Drawer: WCR6802 8 Action: sale Board; A Claim Check #: 08259 01251 Transaction $1 5.00 Card Type: Debit Card Holder Name: MCCOVERY/CHRISTIAN M Account: xxxxxxxx-6014 Card#: XXXX-XXXX-XXXX-6014 Name' MCCOVERYICHRISTIAN M Card Type; M/C Approval: 006964 Auth. #: 021091 X Amount Charged: 30.00 Customer Signature Signature All Prescription Sales Are Final , Unopened Over-The-Counter items may be returned for Refund within 30-Days with original receipt. PATIENT COPY THANK YOU FOR CHOOSING KAISER PERMANENTE :At-nA T (0 C-1 W :W=qt 0 S -1 0 !k'0 �- 9- O e+ Lq CA Ln 2)M 9D >C co 0)(D 0) on 01 (D CD 0, 2 un 2 ;"q) 0 0 co CD W to M "ro" Ln X� to C) X -n —D 9 QtT1 -6 O� �Cn� HC)a — 1 0 (f) W0 "Cc C-) W -X� :�D'+ :AN LO 0) (D —Mz-DP- :0 C') 'a en c> M DO ZE 0) 0'0 in CU37 V C">��� x47' 0) C')C) 00 Q) (Oji an a 'I (f) 0 —1-i C) 4D<(0 CL 0)CD a (b 000 -3 (1) 0 0 0 2�.C')(n (D tv 0 1 X.�= M (D C) ;r AWN n-0) -3 CA X 0 Ic 1+ �cp �0 C-) M CL — 0 C:)L"C)0 0 z.(f) (In C O 0 ::) 0 (M�� (D 1+ me • 0 CD Xi(D -00 co :3 CD M (0 (D (P 0 Q) r4 0 CA 3 CD (D CD co CD p c::>:y CD 0 CL'o 0 C) C) (D �3CD cn�66 m0R (P C> CD CL r 1NVOlCE ' Aiv 2,779 WFn www.amr-inc.corr American Medical Response - AMERICAL RESPONSE WEST P.O. Box 3429 Modesto, CA 95353TRtP 401-87577183-00 AC.,", 003599015 PATIENT NAME< CHRISTIAN MCCOVERY DATE 0�SRvtGF 09/14/2008 ACCOUNT NUMBER: 003599015 A IOUNT t3uE_. 1 , 299.84 ui DATE 11/06/200 CHRISTIAN MCCOVERY REMIT PAYMENT TO: 320 HAWK RIDGE DR SAN PABLO CA 94806-5808 AMERICAN MEDICAL RESPONSE ILI��J�J6�IJL��Jh��IJd��IJI��J�J���IJII���II���I FILE 73329 PO BOX 60000 SAN FRANCISCO, CA 94160-3329 -LEASE CHARGE MY: ❑VISA ❑MASTERCARD ❑DISCOVER ❑AMERICAN EXPRESS ACCOUNT E❑11 El 111111111111111111111111 EXPIRATION DATE ❑❑ AMOUNT PAID$ BARD HOLDER NAME(PRINT): SIGNATURE: PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT grsACCOUNTMNO� ,, , , .. TRIPFNO;, R r , ,. =INVOICE=DATEr CHRISTIAN MCCOVERY 003599015-0001 401-87577183-00 10/07/2008 DATE:'.OF SER1%ICE w ? :. 3 SERUI E'FROM °� m w r. '*"ON 4. ^�� t " .. .� CSERVICETO 09/14/2008 SAN PABLO AVE—RCH/RICHMOND PKW 1KAISER RICHMOND HOSPITAL r`,�t..i Awm " 1t7:v ^" 4 A .E'l'i Iw x •p fA veNn,.A� Our records indicate that this transport was the result of an auto accident. Please provide us with your auto insurance informaton . Please contact our Customer Service Department at (800) 913-9106 if you have any questions. Thank you. , CODE„ DESCRIPcTION ,3a d* l' .ONITS`ry,��.UNjT�rCHARGE ,,�� TOT/1' -A%1FiGE A0427 ALS1 EMERGENCY 1 11198.56 11198 . 56 A0425 ALS MILEAGE 4 25. 32 101.28 CALL RCVD: 18: 25r=xTA07AL CHARGESDUE N 1 , 299.84 ,DIAGNOSIS: 78096 � srsU . Ff. SEE REVERSE SIDE FOR INSURANCE INFORMATION Send billing inquiries to: American Medical Response, P.O. Box 3429, Modesto, CA 95353 Phone Number: 1-800-913-9106 Keep this portion for your records. The Permanente Medical Group, Inc. MEDICINE 1515 Newell Avenue Walnut Creek,CA 94596-5120 Dept:925-295-4070 Main: 925-295-4000 VISIT VERIFICATION — MEDICINE Date:September24,2008 Christian McCovery was seen in the Medicine Clinic on 9/24/2008. She has been unable to attend work or school from 9/24 through 9/25/08 SIGNATURE AND TITLE SEN SHAW MD CHECK-IN RECEIPT MRN: 110011953182 Name: MCCOVERY, CHRISTIAN Visit Coverage: KP CLASSIC Appt Date/Time: 9/24/08 12 : 00 PM Appt With: SHAW, SEN (M.D. ) Dept: WCRMED Check-In Date/Time: 09/24/08 11 : 52 AM Amount Due: $ 15 . 00 Amount Paid: $ 15 . 00 Source: Cash Ref : Encounter: 31612014892 Acct : 3181033720 Receipt: 7895117 Your health info online. Register at kp.org for a healthier way of life. PRIMARY CARE PROVIDERS GENERAL: CHU, CHARLIE CHIA-HU*OB/GYN PHYSI : RAHIM., ZARGHOONA (M.D. ) FUTURE APPOINTMENTS Date Time Provider Loc/Dept --------------------------------------------------------------------- 10/02/2008 2 : 00 PM F-0/NECK CARE CLASS - SHA SHAA/SHAPTD PREVENTIVE SERVICES LAST DUE Current CRC FOBT/FIT NA Current CRC FSIG/BE NA Current CRC COLONOSCOPY NA DUE ADULT TDAP 1/26/97 Review HEPATITIS B Current CERVICAL SCREEN 2/02/07 2/02/09 Current PNEUMO VACCINE 1/26/51 Current CHOLESTEROL SCREEN NA Current INFLUENZA VACCINE NA Current MAMMOGRAPHY NA The Permanente Medical Group, Inc. NIINOR INJURY CLINIC 1515 Newell Avenue Walnut Creek,CA 94596-5120 Main: 925-2954000 VISIT VERIFICATION - MEDICINE Date:September 15,2008 Christian McCovery was seen in the Medicine Clinic on 9/15/2008. Please excuse from work for 1 week. Thank you. SIGNATURE AND TITLE SACHIN SHRENIK SHAH DO G t Visit Verification Form Page 1 of 1 KAISER PERMA,NEWE. ED 901 Nevin Avenue Richmond, CA 94801-3143 Dept: 510-307-1566 Main: 510-307-1500 Kaiser Permanente Visit Verification Form Patient Name: Christian McCovery Date Of Visit/Advice: 9/14/08 Date of Illness: Christian McCovery was seen in this office Christian McCovery states he/she has been ill and unable to attend Work from 9/14/2008 through 9/14/2008 Generated by DANIEL SETH PINE MD on 9/14/08 http:likaiserpermanente.org Kaiser Permanente Richmond Medical Ctr. about:blank 9/14/2008 McCovery, Christian (MR# 110011953182) Data Source: KP NCAL EB MASTER- REGNEBM After,VISK S Christ 0 .1' '. umm4fy - PATIENT iin:Mr_qq*er.yjMRNii0 11953182Y�, CONPIDtNTIAL. Visit Information Pr viderDepartment DeptPhone 10/06/2008 2:15 PM ZARGHOONA RAHIM Alm-Gyn* >Central Ave 510-752-1100 MID Your Primary Care Providers P..rovider:. pcp. —pe ID zARGHOONA RAHIM MOB/GYN .Physician CHARLIE CHIA-HUNG CHU MD General Visit Summary Vitals - Last Recorded BPIPulse P se Wt 122/78 104 5'9" 130 lb 12.8 oz (59.33 kg) BMI Data ...:.,.Body M e.x :::::­..: Body y.Surface.Area:::: Index : 1 1. 19.32 (kg/m"2) 1.70 (m^2) Medications Pharmacy Ph N armacy me a RCH MAIN Pharmacy Address and Hours Add H Address Pqrs,._. 901 Nevin Ave M - F 0900-2030; Sat-Sun 0900 - 1730 RICHMOND, CA 94801 Orders Orders Placed During This Visit Norm I Class MICROBIOLOGIC SMEAR W INTERPRETATION, WET Back Office MOUNT W SIMPLE STAIN GYN CYTOLOGY OP Future., .: Glass xpires,,, CHLAMYDIA/GC, SWAB AMPLIFIED PROBE TECHNIQUE OP 6/6/0,9- HOLD HPV FOR FUTURE TESTING OP 3/5/09 HBSAG OP 6/6/09 HEPATITIS C ANTIBODY OP 6/6/09 HIV 1/2 ANTIBODY OP 6/6/09 T PALLIDUM IGG + IGM OP 6/6/09 Standing, Glass Expires .... Printed by Rahim, Zarghoona 10/6/08 2:42 PM Page 1 of 2 MGCovery, Christian (MR# 11DO11953182) Data Source: KPNCALEBMASTER` RE{3NEBM Ord (continued) VACCHUMAN PAPILLOK8AV|RU8. QUADRIVALENT, 3 Back Office 10/6/09 DOSE SCHEDULE, i/mE& Allergies Allergies of 10/6/2008 Date Reviewed: 9/24/2008 (No Known Allergies) Instructions and Follow-Up Patient Instructions Human Papillomavirus (types 6, 11, 16, 18)Vaccine HPV is a common virus that can cause genital warts and cancer. HPV is spread by sexual contact. It is estimated that over 50% Aypeople will get HPV otsome time although most infections are without symptoms and can clear by themselves. The vaccine isgiven au3doses: the first dose iafollowed byasecond dose 2months later, and mthird dose G months after the first dose. /tisimportant toreceive all doses. The vaccine is very effective in preventing four types of HPV in young women who have not been previously exposed. The vaccine will not treat HPV infection that is already present or its complications. The vaccine covers the most common types of HPV but does not provide protection against all types of HPV.That is why women will still need regular cervical cancer screening, even after they have received the HPV vaccine, The most common side effect immild pain atthe site where the vaccine isgiven. The HPV vaccine is not recommended inpregnancy. Recommended vaccination for girls 11-12years ofage. Girls and women between 8and 26years ofage are also candidates for vaccination, but It is preferred that all three doses of the vaccine be given before girls become sexually active. Kaiser Permanente is in the process of reviewing all evidence to date in order to determine which of our members will benefit most. For more information about HPV, Quto mywebsite via htio:/kmv*w.penmonantaoaUdoctor/. Click onthe links tg Women's Health Education, then GynConcerns, then Human Papilloma Virus (HPV). Appointment Information Future Appointments 10/06/08 2:15 OFFICE VISIT ALM-GYN* >CENTRAL RAHIM, ZARGHOON..A 15 PM AVE (M.D.) HOURS OF OPERATION: RENTAL - CLOSED An PAYLESSendent nCAR RENTAL Sun 8:00 AMse of Mon-Fri:7:00 A 0:00 PM PM RA#: 18572 Sat:8:00 AM-4:00 PM 10 HEGENBERGER RD/GA 'UNIT DETAILS* Oakland,CA 94621 UNIT#: 75114 DATE/TIME DUE:09/24/200819.30 PH# (510)638-1000 FAX# MAKE: TOYO MODEL: COR DATEITIME EXT: COLOR: WHITE DATE/TIME IN: 09/24/2008 19.30 "RENTER" LIC#: 5XDX922 DATE/TIME OUT:09/21/2008 19.52 CHRISTIAN MCCOVERY MILES/KM IN: 40,641 MILES/KM FREE:O/DAY 0/WEEK 0 /MON 549 BUENA VISTA AVE 9 MILES/KM OUT: 40,331 ALAMEDA, CA 94501 TOTAL MILES/KM: 310 Daily(sp) 3 25.00 day 75.00 HOME PH:(925)381-8121 TOTAL MILES/KM ALLOWED: 0 Net T&M 75.00 DL NUM: 63247385 STATE:CA FUEL OUT: 8/8THS EXP DATE:01/26/2012 FUEL IN: 8/8THS Underage Driver3 25.00 day 75.00 DOB: 01/26/1986 AGE: 22VEHICLE REPLACEMENT AIRPORT TRANS FEE 1 7.00 unit 7.00 /0 SSN: CA TOURISM FEE 2.500 3.75 EMPLOYER: UNIT#: CA SALES TAX OAK 8.750 % 13.13 PH: MAKE MODEL: AIRPORT CONC. FEE 11.100 % 16.65 COLOR: Subtotal of Other Charges 115.53 LOCAL CONTACT: LIC#: MILESIKM IN: Total Charges 190.53 MILES/KM OUT: NO DRIVERS UNDER 21 YEARS OF AGE AND TOTAL MILES/KM: Payment MC 52XX 6014 190.53 NO UNAUTHORIZED DRIVERS FUEL OUT: /8THS Total Deposits/Payments 190.53 "ADDITIONAL AUTHORIZED DRIVER(S)" FUEL IN: /8THS NONE: "RENTERS INSURANCE" GEICO Policy#: AGE 0 CREDIT CARD INFO: CHECKED OUT BY: DMITRIY MC 52XXXXXXXXXX6014 EXP DATE: Damage AUTHORIZATION#: 028129 (RENTER ACKNOWLEDGES ATTACHED VEHICLE CONDITION FORM.) AUTHORIZATION AMT:250.00 CHECKED OUT BY: DMITRIY CHECKED IN BY: DMITRIY VEHICLE CONDITION: Renter's Signature PAYMENT SUMMARY DUE FROM COMPANY Payments: MC 0.00 09/24/2008 0.00 0.00 190.53 190.53 190.53 This document printed on 09/24/2008 at 19:33:38 McCovery, Christian(MR#110011953182) Data Source: KIP NCAL EB MASTER- REGNEBM After.V Isit Summary 1 . .w.'PATIENT' : �Christian MCC N,(MRN.11001195.3.1.8.2) NFIDENTIAL�.��:��..­.... Visit Information Pro ider: V. Department i Dept Phone 09/15/2006 0:00 OM SACHIN SHRENIK Wcr-Mic* >Main Campus SHAH DO Your Primary Care Providers Provider . PGP Type..: ZARGHo6NA RAHIM MID OB/GYN Physician CHARLIE CHIA-HUNG CHU MID General Visit Summary Vitals - Last Recorded BP Temp 121/81 83 68.6 OF (37 -C) Medications Prescriptions Ordered During This Visit Endd n SUPROFEN 600 MG ORAL TAB 60 0/0 9/15/2008 Sig: TAKE 1 TABLET ORALLY EVERY 6 HOURS WITH FOOD AS NEEDED FOR PAIN Class: Fill Now Route: Oral CYCLOBENZAPRINE 10 MG ORAL TAB 30 0/0 9/15/2008 Sig: TAKE 1 TABLET ORALLY 3 TIMES A DAY AS NEEDED FOR MUSCLE SPASM Class: Fill Now Route: Oral HYDROCODONE-ACETAMINOPHEN 5-500 MG ORAL 7 0/0 9/15/2008 TAB Sig: 1 po qhs prn mod-severe pain Class: Fill Now Route: Oral Pharmacy 'PharmapyN. ame WCR DISCHARGE 1ST FL Pharmacy Address and Hours Address Hours:: 1425 South Main St 24 Hours WALNUT CREEK, CA 94596 Allergies Allergies as of 9/1512008 Date Reviewed: 9/14/2008 (No Known Allergies) Instructions and Follow-Up Patient Instructions Whiplash Your Kaiser Permanente Care Instructions Printed by Shah, Sachin S.( D. 0.)9/15/08 9:19 PM Page 1 of 3 McCovery, Christian(MR# 110011953182) Data Source: KP NCAL EB MASTER- REGNEBM Instructions and Follow-Up (continued) Patient Instructions (continued) Whiplash occurs when your head is suddenly forced forward and then snapped backward, as might happen in a car accident or sports injury. This can cause pain and stiffness in your neck. Your head, chest, shoulders, and arms also may hurt. Most whiplash gets better with home care. Your doctor or other clinician may advise you to take medicine to relieve pain or relax your muscles. He or she may suggest exercise and physical therapy to increase flexibility and relieve pain. You may need to wear a neck (cervical)collar to support your neck. For a while you probably will need to avoid lifting and other activities that can strain the neck. How can you care for yourself at home? -Take pain medicines exactly as directed. - If the doctor or other clinician gave you a prescription medicine for pain, take it as prescribed. - If you are not taking a prescription pain medicine, take over-the-counter anti-inflammatory medicines to reduce pain and swelling. These include ibuprofen (Advil, Motrin), naproxen (Aleve), or ketoprofen (Orudis). Read and follow all instructions on the label. - Do not take two or more pain medicines at the same time unless the doctor or other clinician told you to. - If your doctor or other clinician recommends a neck collar, wear it exactly as directed. - Put ice or a cold pack on your neck for 10 to 15 minutes at a time. Put a thin cloth between the ice and your skin. -Avoid things that might increase swelling, such as hot showers, hot tubs, or hot packs, for the first 2 days after a neck injury. -You can use a warm pack or heating pad set on low 2 days after a neck injury if you do not have swelling. Some doctors recommend taking turns between heat and cold. - Do not do anything that makes the pain worse. Take it easy for a couple of days. You can do your usual activities if they do not hurt your neck or put it at risk for more stress or injury. Avoid lifting, sports, or other activities that might strain your neck. -Try sleeping on a special neck pillow. Place it under your neck, not under your head. Placing a tightly rolled-up towel under your neck while you sleep will also work. If you use a neck pillow or rolled towel, do not use your regular pillow at the same time. - Once your neck pain is gone, do exercises to stretch your neck and back and make them stronger. Your doctor other clinician, or physical therapist can tell you which exercises are best, Follow-up care is a key part of your treatment. Be sure to make any suggested appointments and go to all scheduled visits. Watch for signs that you are not getting better as expected, and call your doctor or other clinician if you have concerns. When should you call 911? If you think you are experiencing a medical emergency, call 911 immediately or seek other emergency services. Examples of symptoms that may be an emergency include: -Your arms and legs feel weak or numb. -You cannot move one or both arms or legs. You cannot control your bowels or bladder. When should you call Kaiser Permanente? -Your neck pain keeps you from moving your head. -Your neck pain is getting worse. -You do not get better as expected. -You have any new symptoms. -Your neck pain comes back after going away for a few days. -You have any problems with your medicine. Printed by Shah, Sachin S.( D. O.) 9115108 9:19 PM Page of 3 McCovery, Christian (MR# 110011953182) Data Source: KP NCAL EB MASTER - REGNEBM Instructions and Follow-Up (continued) Patient Instructions (continued) How can you learn more about whiplash? - Log on: members.kp.org. Search for neck problems in the Health encyclopedia. - Look in: Kaiser Permanente Healthwise Handbook. Care Instructions adapted by Kaiser Permanente from Healthwise, Incorporated©2006. All rights reserved. Appointment Information Future Appointments Oate Time Visit Type Department Provider Length 9/15/08 9:00 OFFICE VISIT WCR-MIC* >MAIN SHAH, SACHIN 15 PM CAMPUS SHRENIK(D.O.) 9/18/08 2:00 CLASS - FEE SHA-PTDB >LENNON F-0/NECK CARE 120 PM LANE CLASS -SHA Printed by Shah, Sachin S.( D. 0.)9/15/08 9:19 PM Page 3 of 3 Page 1 of 4 KAISER RCH-HOSPITAL MCCOVERY,CHRISTIAN RICHMOND, CA 94801-3143 MRN: 110011953182 FOUNDATION DOB: 01/26/1986, Sex: F HOSPITAL Adm: 09/14/2008 ,D/C: Discharge a Instructions FAR$ KAISER PERMANENTEe RICHMOND MEDICAL CENTER EMERGENCY DEPARTMENT 901 NEVIN AVE RICHMOND, CA 94801 PHONE: (510) 307-2190 Patient: Christian McCovery MRN: 110011953182 You were treated by : Pine,Daniel Seth (M.D.) GENERAL DISCHARGE INSTRUCTIONS: Neck Strain Your Kaiser Permanente Care Instructions You have strained the muscles and ligaments in your neck. A sudden, awkward movement can strain the neck—this often occurs with falls or car accidents or during certain sports. Everyday activities like working on a computer or sleeping can also cause neck strain if they force you to hold your neck in an awkward position for a long time. It is common for neck pain to get worse for a day or two after an injury, but it should start to feel better after that. You may have more pain and stiffness for several days before it gets better. This is expected. It may take a few weeks or longer for it to heal completely. Good home treatment can help you get better faster and avoid future neck problems. How can you care for yourself at home? . If you were given a neck brace (cervical collar) to limit neck motion, wear it as instructed for as many days as your doctor or other clinician tells you to. Do not wear it longer than you were told to. Wearing a brace for too long can make neck stiffness worse and weaken the neck muscles. . Put ice or a cold pack on your neck for 10 to 15 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin. Kaiser Permanente Richmond Medical Ctr. Christian McCovery 110011953182 Page 1 of 4 Page 2 of 4 . Take pain medicines exactly as directed. o If the doctor or other clinician gave you a prescription medicine for pain, take it as prescribed. o If you are not taking a prescription pain medicine, take an over- the- counter pain medicine such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label. No one younger than 20 should take aspirin. It has been linked to Reye's syndrome, a serious illness. o Do not take two or more pain medicines at the same time unless the doctor or other clinician told you to. . Gently rub the area to relieve pain and help with blood flow. Do not massage the area if it hurts to do so. . After 3 days, if the swelling is gone, you can use heat for 10 to 15 minutes at a time. Use a warm pack (such as a hot, wet towel) or a heating pad set on low. Hot showers will also help. You can switch back and forth between cold and hot if this helps the pain. . Do not do anything that makes the pain worse. Take it easy for a couple of days. You can do your usual activities if they do not hurt your neck or put it at risk for more pain or injury. . Try sleeping on a special neck pillow. Place it under your neck, not under your head. Placing a tightly rolled-up towel under your neck while you sleep will also work. If you use a neck pillow or rolled towel, do not use your regular pillow at the same time. . To prevent future neck pain, do exercises to stretch and strengthen your neck and back. Learn how to use good posture, safe lifting techniques, and proper body mechanics. Follow-up care is a key part of your treatment. Be sure to make any suggested appointments and go to all scheduled visits. Watch for signs that you are not getting better as expected, and call your doctor or other clinician if you have concerns. When should you call 911? If you think you are experiencing a medical emergency, call 911 immediately or seek other emergency services. Examples of symptoms that may be an emergency include: . You lose bladder or bowel control. . You have weakness in your arms or legs. When should you call Kaiser Permanente? . You have new pain, numbness, or tingling in your arms, hands, or legs. . Your neck pain gets worse. . Your neck pain is not better after 1 week. It may take longer for the pain to go away completely, but it should feel at least a little better. How can you learn more about neck strains? . Log on: members.kp.org. Search for neck pain in the Health encyclopedia. . Look in:Kaiser Permanente Healthwise Handbook. Kaiser Permanente Richmond Medical Ctr. Christian McCovery 110011953182 Page 2 of 4 Page 3 of 4 Your Kaiser Permanente Care Instructions adapted from Healthwise, Incorporated (c) 2005. All rights reserved. SPECIAL INSTRUCTIONS: Additional information regarding your condition can be found at your doctor's personal website or that of Kaiser Permanente (www.members.kaiserpermanente.org). You may have had diagnostic tests. Any results from these tests that are not available at the time of the visit will be reviewed as they become available. You will be contacted if any results require a change in your treatment. FOLLOW UP: Call 307-1722 and ask for Dr. Pine to get the ' results of your urine test Return to the Emergency Department if you are unable to obtain the recommended follow-up treatment, or if the condition for which you were seen should get worse, or you are not better as expected. CALL 911 IF YOU THINK YOU ARE HAVING A MEDICAL EMERGENCY. Your medications instructions from your Emergency Care Provider No active medications on file as of 09/14/2008 Above is a list of medications that you were taking before your Emergency Department visit today, based upon the information we were able to obtain. This list also includes any new medications that were prescribed for you during this visit. Below is a list of the new medications prescribed today and medications you are being instructed to stop taking. Pick up the following prescribed medicines at : . Acetaminophen (Tylenol) as needed Advil (Motrin, Ibuprofen) as needed (also ok IF your pregnancy test is negative) WARNING: You may have received a drug that may cause drowsiness. Do not drive or drink alcoholic beverages for 8 hours or until you are sure the effects of the drugs have worn off. If in doubt, please ask your nurse. Kaiser Permanente Richmond Medical Ctr. Christian McCovery 110011953182 Page 3 of 4 Li4TEr`NQT/CE; � :L -A& ETZ l�TICE A1P 2,327 -^ www.amr-inc.com American Medical Response — AMERICA EDICAL RESPONSE WEST P.O. Box 3429 Modesto, CA 95353 TRtp ; 401-87577183-00 CGT : 003599015 PATIENT NAME _..._.__... ...._......:: : CHRISTIAN MCCOVERY DA`i`E OF tAy,CE 09/14/2008 ACCOUNT NUMBER: 003599015 AMOUNT QUE 1 , 299.84 DUE DATE 11/20/200 _._._. 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