Preview
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
3:33 North Shore University Hospital
[++ Northwell Health~
North Shore-LU Health System is now Northwell Health
Health Information Management
Date:
CERTIFICATION
1 Wayne Maldonado, Associate Director, Health Information Management of North
Shore University Hospital, 300 Community Drive, Manhasset, New York, hereby certify
that the record attached is in the custody of and is the full and complete record of the
condition, act, transaction, occurrence or event of this institution Conceming:
Patient’s Name Dine > ao Uta
Medical Record Number: Gs 415
I farther certify that the record was made in the regular course of business of this
institution and it is the regular course of business of the institution to make such record
and such record is made at the time of the condition, act, transaction, occurrence or event,
or within a reasonable time thereafter.
Ws a 18
As die Director
Health Information Management oT Co oo
300 Community Drive | Manhasset, NY11030 |.
000001
000001
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
vo .
HS
ExitCare® Patient Information - DINO BONAVITA - ID# 100014797391 - MR# 188919
i
"North Shore ARR N - th | I] Emergency
University Hospital hh ~ “ or e | Department
ir
LI 7
300 Community Drive - | Ith 516) 562-4125
Manhasset, NY 11030 TENN ca (516)
CONFIDENTIAL
EXITCARE® PATIENT INFORMATION
Patient Information:
Patient
Pati DOB: MMM968 ent Gender: M
REDACTED
[Patient Phone Number: (516)484-1017
WN
[1
. Visit Information;
sit Date: 7/21/2017 Department: ED
Primary Caregiver: Underwood, Philipp J 0
Primary Follow-up Info: .: Syed Sayeed, MD - Long Island Jewish Medical Center; Glen Cove Hospi 139 Plandome Road Manhasset
NY 11030 (516)439-5160 Location
it
"User Information:
Pa
~ “ipgin
{
ID: Generic User Name: Generic User DeptED
aa
>>>> NH NSUH ED Discharge Instructions - English - {DABC9CF3-DA79-46F1 -SE92.-E4D7B378B643}
This Document has either been modified or created by the issuing facility or caregiver.
Additional Follow-up caregivers:
Additional Notes:
ge hydrating |
ation of your affected hand,
eep on a splint,
Motrin 600mg every 8hours for pain with food.
Keflex 500mg every 6hours for 7days.
+... Follow up with hand specialist Dr. Sayeed as scheduled, call on Monday for appointment,
~ Please follow up with your Primary MD in 24-48 hr,
* Seek immediate medical care for any new/worsening signs or symptorns.
>»>> |aceration Care, Adult - English - {BE23319B-9BEF-4767-8E40-24DB5363DD16)
Additional Follow-up caregivers:
Additional Notes.
Please follow up with vour Primary MD in 24-48 hr,
'_. Seek immediate medical care for any new/worsening signs or symptoms.
>»>> Mallet Finger - English - {DC4033E9-B448-4979-9DF8-0D2151629740)
Additional Follow-up caregivers:
“ditional Notes:
ae
ase follow up with your Primary MD in 24-48 hr.
Seek immediate medical care for any new/worsening signs or symptoms.
112 ©2017 ExitCare, LLC 7/21/2017 11:15:57 PM
000033
000033
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
t=" . [ o™
ExitCare® Patient Information - DINO BONAVITA - ID# 100014797391 - MR# 188919
- _ Signature ack at. Patient and/or Guardian has re 2d these insiructions and understands them.
Patlerd 0 Time /Date \Witnesseg & Instructed by Time/Date
pA
SIGNATURE PAGE
2/2 ©2017 ExitCare, LLC 7/21/2017 11:15:57 PM
000034
000034
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
131 North Shore University Hospital EMR © 7 100014797391
I Northwell Health BONAVITA, DINO
North Shore-Ll] Health System is now Northwell Health =
= MR 188919 UNK . M 48 Y
= DpocTOR UNKNOWN ~~ [J1968
REDACTED
JERR
RELEASEOF INFORMATION = | héreby alithand orizé direct the above named facility and its physicians having treated me ©
release to government agencies. all or part of the patient's record to any person or corporation which is or may-be liable under
contract io the Medical facility or medical service companies, insurance companies, other work compensation carrier, no- fault,
welfare or the patient's employer. Such information may also be released to such governmental agencies as may be deemed to
have a legitimate interest herein.
PERSONAL VALUABLES ~ It is Understood and agreed that the Medical facility cannot accept any responsibility for the loss or
damage of articles which | consider valuable. All patient's. clothing and personal property are to he taken home by the familyat time
of admission: valuables may be left.in the In-patient/cashier office for safekeeping for which receipts will be issued and until they
can be properly claimed up to TEN days.after discharge. | hereby take entire responsibility for retaining in my own possession all
personal property and valuables.
EINANCIAL AGREEMENT ~ The undersigned agrees, Whether hefshe signs as agent or as patient thatin consideration of the -
services rendered to the patient he/she hereby individually obligates: him/herself-to pay the amount of the Medical facility bill in
accordance with the. rates and terms. of the Medical facility. Should the account be referred to an attorney for collection, the
undersigned shall pay reasonable attorney's fees and collection expenses.
ASSIGNMENT TO MEDICAL FACILITY — | hereby assign, transfer and set overto the above named Medical facility sufficient
monies and/or benefits to which | may be entitled from government agencies, insurance carriers, or others who are financially liabie
for my Medical facility and medical care and treatment rendered tome or my dependents in said Medical facility.
Upon admission the patient/patient representative has been given the following notices as required by State & Federal regulations
and has been offered and or given an explanation of each.
Admiission Packet. All Impartant Medicare Information Health Care Proxy Information
Advance Directives All other Insurance Information Patient's/Parent’s Rights & Responsibilities
The undersigned certifies that he/she has receivediread the foregoing, and is the patient-or is duly-authorized by thepatient as the
patient's agent to execute. the above and accept its terms,
The undersigned agrees that consent is.granted to contact the patient or patient agent by any arid all phone numbers provided
or cellular, The undersigned also agrees consent is granted to.contact the patientor patient agent by any and ail
SIZ. on
landline
<
whether
email addresses provided. ;
LRN Th Mr +k
DfofTi fhe 4
A Patien{'s Agent or Representative Relationship to Patient ¢
Pdlientgi gnature
saber and Email Address 721)
/ alls J
Witness oo + DatefTime of Signature”
ASSIGNMENTTO MEDICAL FACILITY (FOR PATIENTS ENTITLED TC MEDICARE BENEFITS) — | certify that the information
given to me in applying for payment under title. XVIII of the Social Security Act is correct. | authorize any holder of the medical or
other information about me to release to the Social Security Administration, or its intermediariesor carriers, any information needed
for this or a related Medicare claim. | request that payment or authorized benefits be made on my behalf. | assign the benefits
payable forphysician services to the physicians or organization furnishing the services, or authorize such physician or organization
to submit a Medicare claim for paymentto me. Based on your individual coverage it may become necessary for you to utilize lifetime
reserve days (LTR), when billing beyond the 90th day of a Medical facility stay. If you choose nottc use your LTR days any charges
incurred after the 90th day will become your responsibility.
0 YES Please use my LTR Days [1 No Do not use my LTR Days
a
Signature of Patientor Authorized Representative © Date/Time
Page 2 6f 2
YDO41A {1012018}
000035
000035
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
fr
0M
vv North Shore University Hospital EMR 100014797391
ww Northwell Heaith-
North Shore-L1) Health System Is now Northwell Health = BONAVITA, DINO
== MR 138919 UNK M 48 Y
= DOCTOR UNKNOWN RE
REDACTED
68
IHN
Consent To Admission And Treatment
| hereby consent fo treatment:and, if applicable, admission to this healthcare facility. | authorize the medical
staff, nursing staff and other personnel fo provide care including telehealth services and fo -administer such
diagnostic, radiological and/or-therapeutic procedures and treatments as the medical staff determines is
necessary or advisable in my care, or, for obstetrical patients, in the care of my baby. If | am signing this
document on behalf of another person, | acknowledge that |.am consenting on behalf of this patient and |
will indicate the relationship (parent, relative, health care agent, guardian, surrogate) where indicated below.
| authorize release of certain information including but not limited to immunization records to state and federal
registries. If a healthcare worker involved in my care and treatment becomes exposed to-certain bodily fluids
resulting in the possibility of transmission of a bloodborne disease, my blood will be tested for HIV, Hepatitis
Ea
3
B, Hepatitis C and other potential bloodbome communicable diseases to determine riskof exposure to the
healthcare worker. |
In compliance with EMTALA, Northiwell Health Hospitals with Dedicated Emergency Departments (DED) will
offer Emergency medical care, as indicated by an individual's medical condition, to all individuals arriving at
the Northwell Health Hospital for Emergency examination or treatment without regard to the individual's
insurance status,
| acknowledge that this form authorizes releases. of my HIV. Hepatitis B. Hepatitis C and other potential
bloodborne communicabie diseases results to the healthcare: worker-accidentally exposed to my blood and
their health professional for purposes of providing post-exposure care. | understand that these individuals
are prohibited by law from re-disclosing my testing results in.a way that could reveal my identity.
| acknowledge that this form authorizes my healthcare team to discuss information related to my. post
discharge support and care with the individual named as my caregiver.
| understand that if | have provided Emergency Contact names that the facility considers these individuals
as my "Designated Representative(s).” This facility may share my protected health information (“PHI”) with
my Designated Representative(s) to the extent permitted by law and to the extent that | have directed
otherwise.
Electronic Medication History: | authorize Northwell Health System 16 retrieve my fedicatior history
through their e-“prescribing Sygent and then import it into y electronic medical record:
-
Patient/Agent/Reiative/Guardian® (Signature Date A Print Name if other than patient
} elephon iG Interpreters 10 Date 7 Time
SRY; “Al s Name and Relationship to Patient
‘Signature: Interpreter
‘Witness tbgignature (Slanaturer™ Date
* The signature. of the patient must be obtained unless the patiett is an uriémancipatéd minor under the.age of 18 or is otherwise incapable-of signing.
Page 4 of 2
VDO11 {10/26/46)
000036
000036
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
NORTHWELL HEALTH
North Shore University Hospital
MANHASSET, NEW YORK 11030 Phone: (516) 562-4822 Fax: (516) 562-4794
Department of Radiology
Patient: BONAVITA, DINO
AKA: BONAVITA, DINO
’ MR#: 188919 EPI #: 451887
poB: [1968
REDACTED
AGE: 48Y MALE
Acct #: 100014797391 Pt Class: EMERGENCY ROOM
Location: EMR \ NSUH Emergency
Order Loc:
Ordered By: PHILIPP UNDERWOOD, ATTENDING EM
PHYSICIAN
Order #: 90002 Accession #: 35468497
Dsch Date:
EXAM: HAND 2VIEWS RT
PROCEDURE DATE: 07/21/2017
INTERPRETATION: CLINICAL INDICATION: Evaluate for foreign body. Hand laceration.
TECHNIQUE: 3 views of the right hand.
COMPARISON: Right wrist radiographs 7/12/2017.
IMPRESSION:
No radiopaque foreign body is visualized. There is no acute fracture or dislocation of the right hand. Mild first
CMC joint arthrosis is noted.
PAUL-MICHEL DOSSOUS M.D., RADIOLOGY RESIDENT
This document has been electronically signed.
MICHAEL BROWN M.D., ATTENDING RADIOLOGIST
This document has been electronically signed. Jul 22 2017 6:26AM
MICHAEL BROWN M.D., ATTENDING RADIOLOGIST
As the Attending Physician, |personally performed the professional interpretation of the study, personally supervised the professional interpretation of the study and/or reviewed the
images and the interpretation of the resident, and have edited the report where appropriate. If this is an Interventional or invasive procedure, | personally performed or was present and
supervised the critical or key portions of the procedure, and have written or reviewed and edited the report where appropriate.
Page 1 of 2 Date Printed: 10/5/2018 9:36 AM
000037
000037
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022
NORTHWELL HEALTH
North Shore University Hospital
MANHASSET, NEW YORK 11030 Phone: (516) 562-4822 Fax: (516) 562-4794
Department of Radiology
Patient: BONAVITA, DINO MRN: 188919 Patient #: 100014797391 Proc Date: 07/21/2017 Ord #: 90002
Preview
FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 3:33 North Shore University Hospital [++ Northwell Health~ North Shore-LU Health System is now Northwell Health Health Information Management Date: CERTIFICATION 1 Wayne Maldonado, Associate Director, Health Information Management of North Shore University Hospital, 300 Community Drive, Manhasset, New York, hereby certify that the record attached is in the custody of and is the full and complete record of the condition, act, transaction, occurrence or event of this institution Conceming: Patient’s Name Dine > ao Uta Medical Record Number: Gs 415 I farther certify that the record was made in the regular course of business of this institution and it is the regular course of business of the institution to make such record and such record is made at the time of the condition, act, transaction, occurrence or event, or within a reasonable time thereafter. Ws a 18 As die Director Health Information Management oT Co oo 300 Community Drive | Manhasset, NY11030 |. 000001 000001 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 vo . HS ExitCare® Patient Information - DINO BONAVITA - ID# 100014797391 - MR# 188919 i "North Shore ARR N - th | I] Emergency University Hospital hh ~ “ or e | Department ir LI 7 300 Community Drive - | Ith 516) 562-4125 Manhasset, NY 11030 TENN ca (516) CONFIDENTIAL EXITCARE® PATIENT INFORMATION Patient Information: Patient Pati DOB: MMM968 ent Gender: M REDACTED [Patient Phone Number: (516)484-1017 WN [1 . Visit Information; sit Date: 7/21/2017 Department: ED Primary Caregiver: Underwood, Philipp J 0 Primary Follow-up Info: .: Syed Sayeed, MD - Long Island Jewish Medical Center; Glen Cove Hospi 139 Plandome Road Manhasset NY 11030 (516)439-5160 Location it "User Information: Pa ~ “ipgin { ID: Generic User Name: Generic User DeptED aa >>>> NH NSUH ED Discharge Instructions - English - {DABC9CF3-DA79-46F1 -SE92.-E4D7B378B643} This Document has either been modified or created by the issuing facility or caregiver. Additional Follow-up caregivers: Additional Notes: ge hydrating | ation of your affected hand, eep on a splint, Motrin 600mg every 8hours for pain with food. Keflex 500mg every 6hours for 7days. +... Follow up with hand specialist Dr. Sayeed as scheduled, call on Monday for appointment, ~ Please follow up with your Primary MD in 24-48 hr, * Seek immediate medical care for any new/worsening signs or symptorns. >»>> |aceration Care, Adult - English - {BE23319B-9BEF-4767-8E40-24DB5363DD16) Additional Follow-up caregivers: Additional Notes. Please follow up with vour Primary MD in 24-48 hr, '_. Seek immediate medical care for any new/worsening signs or symptoms. >»>> Mallet Finger - English - {DC4033E9-B448-4979-9DF8-0D2151629740) Additional Follow-up caregivers: “ditional Notes: ae ase follow up with your Primary MD in 24-48 hr. Seek immediate medical care for any new/worsening signs or symptoms. 112 ©2017 ExitCare, LLC 7/21/2017 11:15:57 PM 000033 000033 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 t=" . [ o™ ExitCare® Patient Information - DINO BONAVITA - ID# 100014797391 - MR# 188919 - _ Signature ack at. Patient and/or Guardian has re 2d these insiructions and understands them. Patlerd 0 Time /Date \Witnesseg & Instructed by Time/Date pA SIGNATURE PAGE 2/2 ©2017 ExitCare, LLC 7/21/2017 11:15:57 PM 000034 000034 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 131 North Shore University Hospital EMR © 7 100014797391 I Northwell Health BONAVITA, DINO North Shore-Ll] Health System is now Northwell Health = = MR 188919 UNK . M 48 Y = DpocTOR UNKNOWN ~~ [J1968 REDACTED JERR RELEASEOF INFORMATION = | héreby alithand orizé direct the above named facility and its physicians having treated me © release to government agencies. all or part of the patient's record to any person or corporation which is or may-be liable under contract io the Medical facility or medical service companies, insurance companies, other work compensation carrier, no- fault, welfare or the patient's employer. Such information may also be released to such governmental agencies as may be deemed to have a legitimate interest herein. PERSONAL VALUABLES ~ It is Understood and agreed that the Medical facility cannot accept any responsibility for the loss or damage of articles which | consider valuable. All patient's. clothing and personal property are to he taken home by the familyat time of admission: valuables may be left.in the In-patient/cashier office for safekeeping for which receipts will be issued and until they can be properly claimed up to TEN days.after discharge. | hereby take entire responsibility for retaining in my own possession all personal property and valuables. EINANCIAL AGREEMENT ~ The undersigned agrees, Whether hefshe signs as agent or as patient thatin consideration of the - services rendered to the patient he/she hereby individually obligates: him/herself-to pay the amount of the Medical facility bill in accordance with the. rates and terms. of the Medical facility. Should the account be referred to an attorney for collection, the undersigned shall pay reasonable attorney's fees and collection expenses. ASSIGNMENT TO MEDICAL FACILITY — | hereby assign, transfer and set overto the above named Medical facility sufficient monies and/or benefits to which | may be entitled from government agencies, insurance carriers, or others who are financially liabie for my Medical facility and medical care and treatment rendered tome or my dependents in said Medical facility. Upon admission the patient/patient representative has been given the following notices as required by State & Federal regulations and has been offered and or given an explanation of each. Admiission Packet. All Impartant Medicare Information Health Care Proxy Information Advance Directives All other Insurance Information Patient's/Parent’s Rights & Responsibilities The undersigned certifies that he/she has receivediread the foregoing, and is the patient-or is duly-authorized by thepatient as the patient's agent to execute. the above and accept its terms, The undersigned agrees that consent is.granted to contact the patient or patient agent by any arid all phone numbers provided or cellular, The undersigned also agrees consent is granted to.contact the patientor patient agent by any and ail SIZ. on landline < whether email addresses provided. ; LRN Th Mr +k DfofTi fhe 4 A Patien{'s Agent or Representative Relationship to Patient ¢ Pdlientgi gnature saber and Email Address 721) / alls J Witness oo + DatefTime of Signature” ASSIGNMENTTO MEDICAL FACILITY (FOR PATIENTS ENTITLED TC MEDICARE BENEFITS) — | certify that the information given to me in applying for payment under title. XVIII of the Social Security Act is correct. | authorize any holder of the medical or other information about me to release to the Social Security Administration, or its intermediariesor carriers, any information needed for this or a related Medicare claim. | request that payment or authorized benefits be made on my behalf. | assign the benefits payable forphysician services to the physicians or organization furnishing the services, or authorize such physician or organization to submit a Medicare claim for paymentto me. Based on your individual coverage it may become necessary for you to utilize lifetime reserve days (LTR), when billing beyond the 90th day of a Medical facility stay. If you choose nottc use your LTR days any charges incurred after the 90th day will become your responsibility. 0 YES Please use my LTR Days [1 No Do not use my LTR Days a Signature of Patientor Authorized Representative © Date/Time Page 2 6f 2 YDO41A {1012018} 000035 000035 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 fr 0M vv North Shore University Hospital EMR 100014797391 ww Northwell Heaith- North Shore-L1) Health System Is now Northwell Health = BONAVITA, DINO == MR 138919 UNK M 48 Y = DOCTOR UNKNOWN RE REDACTED 68 IHN Consent To Admission And Treatment | hereby consent fo treatment:and, if applicable, admission to this healthcare facility. | authorize the medical staff, nursing staff and other personnel fo provide care including telehealth services and fo -administer such diagnostic, radiological and/or-therapeutic procedures and treatments as the medical staff determines is necessary or advisable in my care, or, for obstetrical patients, in the care of my baby. If | am signing this document on behalf of another person, | acknowledge that |.am consenting on behalf of this patient and | will indicate the relationship (parent, relative, health care agent, guardian, surrogate) where indicated below. | authorize release of certain information including but not limited to immunization records to state and federal registries. If a healthcare worker involved in my care and treatment becomes exposed to-certain bodily fluids resulting in the possibility of transmission of a bloodborne disease, my blood will be tested for HIV, Hepatitis Ea 3 B, Hepatitis C and other potential bloodbome communicable diseases to determine riskof exposure to the healthcare worker. | In compliance with EMTALA, Northiwell Health Hospitals with Dedicated Emergency Departments (DED) will offer Emergency medical care, as indicated by an individual's medical condition, to all individuals arriving at the Northwell Health Hospital for Emergency examination or treatment without regard to the individual's insurance status, | acknowledge that this form authorizes releases. of my HIV. Hepatitis B. Hepatitis C and other potential bloodborne communicabie diseases results to the healthcare: worker-accidentally exposed to my blood and their health professional for purposes of providing post-exposure care. | understand that these individuals are prohibited by law from re-disclosing my testing results in.a way that could reveal my identity. | acknowledge that this form authorizes my healthcare team to discuss information related to my. post discharge support and care with the individual named as my caregiver. | understand that if | have provided Emergency Contact names that the facility considers these individuals as my "Designated Representative(s).” This facility may share my protected health information (“PHI”) with my Designated Representative(s) to the extent permitted by law and to the extent that | have directed otherwise. Electronic Medication History: | authorize Northwell Health System 16 retrieve my fedicatior history through their e-“prescribing Sygent and then import it into y electronic medical record: - Patient/Agent/Reiative/Guardian® (Signature Date A Print Name if other than patient } elephon iG Interpreters 10 Date 7 Time SRY; “Al s Name and Relationship to Patient ‘Signature: Interpreter ‘Witness tbgignature (Slanaturer™ Date * The signature. of the patient must be obtained unless the patiett is an uriémancipatéd minor under the.age of 18 or is otherwise incapable-of signing. Page 4 of 2 VDO11 {10/26/46) 000036 000036 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 NORTHWELL HEALTH North Shore University Hospital MANHASSET, NEW YORK 11030 Phone: (516) 562-4822 Fax: (516) 562-4794 Department of Radiology Patient: BONAVITA, DINO AKA: BONAVITA, DINO ’ MR#: 188919 EPI #: 451887 poB: [1968 REDACTED AGE: 48Y MALE Acct #: 100014797391 Pt Class: EMERGENCY ROOM Location: EMR \ NSUH Emergency Order Loc: Ordered By: PHILIPP UNDERWOOD, ATTENDING EM PHYSICIAN Order #: 90002 Accession #: 35468497 Dsch Date: EXAM: HAND 2VIEWS RT PROCEDURE DATE: 07/21/2017 INTERPRETATION: CLINICAL INDICATION: Evaluate for foreign body. Hand laceration. TECHNIQUE: 3 views of the right hand. COMPARISON: Right wrist radiographs 7/12/2017. IMPRESSION: No radiopaque foreign body is visualized. There is no acute fracture or dislocation of the right hand. Mild first CMC joint arthrosis is noted. PAUL-MICHEL DOSSOUS M.D., RADIOLOGY RESIDENT This document has been electronically signed. MICHAEL BROWN M.D., ATTENDING RADIOLOGIST This document has been electronically signed. Jul 22 2017 6:26AM MICHAEL BROWN M.D., ATTENDING RADIOLOGIST As the Attending Physician, |personally performed the professional interpretation of the study, personally supervised the professional interpretation of the study and/or reviewed the images and the interpretation of the resident, and have edited the report where appropriate. If this is an Interventional or invasive procedure, | personally performed or was present and supervised the critical or key portions of the procedure, and have written or reviewed and edited the report where appropriate. Page 1 of 2 Date Printed: 10/5/2018 9:36 AM 000037 000037 FILED: NASSAU COUNTY CLERK 10/12/2022 03:55 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 122 RECEIVED NYSCEF: 10/12/2022 NORTHWELL HEALTH North Shore University Hospital MANHASSET, NEW YORK 11030 Phone: (516) 562-4822 Fax: (516) 562-4794 Department of Radiology Patient: BONAVITA, DINO MRN: 188919 Patient #: 100014797391 Proc Date: 07/21/2017 Ord #: 90002