Preview
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
EXHIBIT I
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
2510 30th ave DANIELS,IVOlRE
Mount ASTORIA NY WI02 MRN: 2457615
SiTMi Entire Chart DOB: W1988, Sex: F
QUMfiS Adm: 1/8/2016 D/C: 1/11/2016
VisitID .
QB370136882
Patient%mmyhles
Najne
fatient . ser. 001 . '. :Address ·! Phone .: '-:.:
Daniels,Ivoire Female 1988 4540 CENTERBLVD 718.808-9367(Home)
APT 2501 917-734-8699(Moblle)
LONGISt.ANDCITYNY 11109
PatientEthnicity& Race
_,_ hnic d|L_: ; . ent Race ..
Non-HIspanic Caucaslan(White
Admission Information
Arrival Dale/Time: 01/08/2018 6:27 PM Admit Date/Time: 01/08/2018 9:16PM (P Adm. Date/Time: 01/09/2016 2:39 AM
AdmissionType EmergencyDepartment Pointof Odgin: Non-healthcareFacility
Admil Category: . None
Meansof Anival: 911 Ems GeneralMedicine· N/A
Primary SeNice: SecondarySeivice:
TransferSource: None ServiceArea: Mount SinalQueens Unit: Maq 6 East
-
Inpatient
Admit Provider None Attending Provider: NathanielP Bonfanti,MD
Referring Provider MolzA Hamdant,MD
Discharge Information
- - DIséhidgedestIriiÈI6ñ "
isWaigaDätedirrie Disaliarge DWi , : :.:
ÛDiiigsagleAnciyider. .½'.r
I,hiit :. :
01/11/2016 1:39AM TransferredTo ShortTerm Msh OtherCare Center None . Msq 5 East
Institution
Events
' to6rn/Bed.·-
Datemine -. Everit Pt Class - : Unit 8Wr2. :.
..01/.10/182 33 Transfer O inpatlant MSQ EICU 600/03 Genom,jyedicine
01/10/162233 Transfer In Inpatient MSQ 5 EAST 609/01 GeneralWIedicine
05/11/100139 Discharge fnpatient MSQ 5 EAST 609/01 GeneralMedicine
Initial
Time Seen by ED Provider
-
- Date/Brne Event ... thier , .. .:- : Gointrients -
. r -.
01/D8/161841 Provider BONFANTI,NATHANIEL
ED Event Log
.. batti/Time Evei ser. .·;
fle
.....u..........e
01/D9/160239 Patient Departure INTERFACE,KEANEADT Triggeredfrom one of the ED end of v sil events.
Allerplesas of 1/11/2016 Reviewed On: 1/11/2016By; OIga Prvstune, MD
sAllerden . ..E. . . : Noted actfan.Ty .. eac s .·:
FentanyI Citrate 01/10/2016 Unknown
.. 8. alle
Fe9,tlanedthat pty to Fentanyl .., . _,,_ ,,_
Fontanyl 09/29/2008 HIves, Itching
severeItchin
Losartan 05/11/2013 Other
ye¼igyg endedness .... ..
Novolog [Insulin Aspart] 06/06/2012 HIves
Imn,üïi:zâtbraand IV Meds
Name . . · .. Date base : Rodt0. àIte. :P : .
INFLUENZAVACCINE Sun Nov 8, 2015 12:25 PM 0.5 mL Intramuscular Rightarm
.. ®M.a to RIce .,,..
INFLUENZAVACCINE 01/09/13 0.5 rnL intrainuscular Left arm
..0)ven By: FemAllen RN
INFLUENZAVACCINE Wed Oct 7, 2009 3:30 PM U.5ml Intramuscular Left deltod
INFLUENZAVACClNE Fri Nov 7, 2008 s;01 PM 0.5 mi intramuscular Right arm
. . ..GivenBy; CrjstinaRoberts ...
Pneumececce! Vaccine 23-VALENT Sun Nov 8, 2015 12:29PM 0.5 mL Intmmuscular Left arm
. ....e Be_me.(dita
RI
TuberculIn PPD intradermal Test Thu Apr 14, 2011 3:11 PM 5 TU Intraderrnal Leftventrical
forearm
Given ByEise Nieves 0
Generated on 7/19/2016 3:22 PM Page 1 ---
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
2510 30th ave DANIELS,IVOfRE i
Moultit ASTORIA NY 11102 MRN: 2457615
Sinal Entire Chart DOB:M1988, Sex: F
Adrn: 1/8/2010, D/C: 1/11/2016
Medical Past Medical History Date Comments Source
as of 1/11/2016 Prernaturhy[PO .30] 3ro ille
Nesidioblastoma [D13.7] s/ppartialpancreatectomy Provider
Beckwith- ViedefriannsyhdrÖiñé [Q 87c3] 9 mo öf aje cltphy..: . ..
rovlyler
heini·hph
Wilm's tumor (nephroblastoma) [C64.9] 18 month s/psurgery x3,chemo Provider
DiatietésmÃIlRus:asso,clatidWith pahoreef 1::7. E.:. . . .. . . Proviiler
I
.disease[Ei1.6sCK86.9] -. .: . . ; .
hypertension [110] 2004 Provider
gingivalhyperplasia.IM8700/0 (ICD-9 CM)] . . Providêt
Bipolardisorder,unspecified[F31.0] 4/06 Provider ¡
ADHD . - .. : Pevider
Microscopic Hematurla 2/12/04 kidney stones Provider ..
Pheochromocytoma NOS (M8700/0 (ICD-9- .5/8/06 paraggreudhi ;: f.ä&enah Provips
- · · ·
CM)J . . .: . .. gland,leftside : .
Adrenal [E27.40]
insufficiency . 11/18/2008 . Provider
Åbdominal painIri10.9] . 5/1.2)2009 : .... ProWÚ r
Acute abdominal pain[R10.0] 5/12/2009 Provlder
S/P exploratorylaparotornyZ98.89] Provider
i qurgeryjZ9B
.kride 89] . ... leif rõvidef .
Paraganglloma [D44.7] Provider
depiession.[F)2 ] . . . . . . . roüldi
Anxiety [F41.9] , Provider
ùicideaveVnptIT14 9 ] ; . . :. γroÿÏd
Tracheal stenosis[J39 8] 3/2012 Provider
Esse i hypéneñsion
I†priniiny) [H0] resolved ; 1P ovii
Sinusltis[J32.G] Provider
spWilnïs dmor [Z88 8 . . :. PröWS
Diabetes [E11.9] secondary to removal of Provider
pancreas
Other'
ecifiéddisogerlitkidneýäiáIñW : .. .Yji:. : Prov'1der:Q- .
S/P R acetabufum biopsy,malignant mass 6/9/2015 Provider
excision,intemalfixationw/bone cement,
explorationof nerveand vessels [Z98.89]
ÚiRE.(systEWEinfdnima ðifre 50y e 1920 o Q ov
$41..9]. - . . $il. .
syndroms) .
Partiherit
Negatives . . : bate Nete0 . Co ninerite oûÑéÏ
Othér Specifiedinfedti.oufandp asiÈc . 5/12/20{ . . iBvid
diseases [B995 B89] ....
Anemia, unspecified [D04,9] 5/12/2015 Provider
Unsfiecified
asthma 93190)[J45 909] 5/12/2015 . . . . Piovide
Cirrhosis without
of liver mention ofalcohol 5/12/2015 Provider
[K74.60]
Other.arid.uns cÏfiedcoagulaUon dèfees 5/f2Ï200 . O EldeÝ
[D68.9] . . . ..
Chronic airway obstructiorhnotelsewhere 5/12/2015 . Provider
classified[J44.9]
Iritecerebrallemorrhagell61 9]. .5/12/2bi5 . ! . tW 8er
Cerebral thrornbosiswithcerebral infarction 5/12/2015 Provider
[i63.30]
\/Iral
hepatihs,Byithoi t mention of,hepatic,- . . - . Provi§gr -
_ 5/12/2015, i.
'' '- - . :-
coma'pcute"or unspecified without mention of ,
hepåtitisdelta[B16.B]
Unspecified hepatitis
viral C without hepatic 5/12/2015 Provider
coma [B19.20]
fidmajiEnidpodefig ertop rus (RjŸ)dise sQRk/2ù15 . üÏd r :
Generated on 7/19/2016 3:22 PM Page 2
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
2510 30th ave . DANIELS,NOIRE
Mond ASTORIA NY 11102 MRN: 2457615
Sinai Entire Chart DOB: 1988, Sex: F
DUGeD$ Adm: 1/8/2016, D/C: 1/11/2016
Obstructivesleep apnea (adult)(pediatric) 5/12/2015 Provider
[G47.33]
Glaucorria[H40;9] . 5/12/2016 . · 1 - . ffovlyei
...
Unspecifiedtransientcerebral ischemia 5/12/2015 Provider
[G45.9]
Autoniatip implantablecardiac denhyaor ir 5/12/2918 .rd9lder
situ[Z95c810]: :. .. . -- : .. . .
Coronary atherosclerosisofüñspecHied type of5/12/2015 Provider
vessel, nativeor graft
[I25.10]
Unspecified ccñg6ñnd anornaly affieert 5/12/2015 .Provider
Congestive heartfailure,unspecified[I50.9] 5/12/2015 Provider
- 5/I2/2015 :. .: .
Old. rnyocardialInfarction
[|25.2]. . - . -. Brovider
. ;
Surgical Past SurgicalHistory Laterality Date Comments
as of 1/11/2016 HX PATENT. DUCTUS NRTER U . . . .. .. . . .
. . . -
C/GATIÒN{SHXž69E .;.
LENGTH/SHORT LEG/ANKL TENDON MULTI 12 yr left
[27686]
TOTAL: NÈ! A5ECTÖMV 4 j8 mo Nl6nteÏÎore .
HX PARTIAL NEPHRECTOMY [SHX414] ag4 yr and 7 yr. due to wilrns,
left
kidney
HX BRÈÄST REDUdTION SURGÈi]Y [äHX8] 4/0 . : ü iÏp{eiafleff
. WnõVed
HX BREAST ENHANCEMENT SURGERY 4/04 unilateral
[SHX7] . right
HX PANCREAS SORGERY :-:- . · . . .hecñ is :. . .P __.0 T
[SHX731]
HX ADRENAL GLAND SURGERY [SHX544] 5/8/08 phoo
Pertsemilids
surgeon
FORIEGN BODY.QR F.IBRIN DEiPCSIT . :. : . - mgdiqptil
a .
HX KNEE SURGERY [SHX244] left
arthroscopy
BRONCRO OPY.[600604] . /31/12 to 2/2/12 . rëpdatéd
RECONSTRUCT WINDPIPE [31780] 3/2/12 Mass
General
Hospital,
Boston
HEREDITARY PARAGANGLlOMA- 3/2013 r¼cu TenL
" "
PHEOCHROMOCYTOMA - GENETIO . .. . __
. .. -
[102423] .
THROMBECTOMY / EMBOLECTOMY 8/5/2013 rightaxillary ¡
AX1LLARY [SUR1352] artery
thrombus
ABliDÑlEN SUlWE'RY PROC INIïSTED . .4.
.. . .
. .., . . .. .
. .. ....., .- .., . . . .. ..,... -
. ... . .. . ... ...
Problem Relation Name Age of Onset Comrnents Source
Family
;
Generated on 7/19/2016 3:22 PM Page 3
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
2510 30th ave DANIELS,IVOlRE
OH ASTORIA NY 11102 MRN: 2457615
Sinai Entire Chart DOB: W1988, Sex: F
Adrn: 1/8/2016, D/C: 1/11/2016
as of 1/11/2016 Glaucoma ..: Family -. : . . . . . ,.i Prayfdep.. .. .
.. -
Ï ÏSSOry ..
Nega6ve for. . .
Diabetes Mellitus Family Provider
History
Negativefor
Hypertendon ·
Fainlly . . ,,' . Provider
'
Negativefo
O er Eye Disease Family Provider
History
Ne ativefor
Asthma . . Sister . . . . . Provider .
Ca ncer Brother bileduct Provider
cancer
Cancer Mother all Providef. ·
bládderi
Tobacco Use Smoking Status Source Types Packs/day Years Camments Smoking Smoking Smokeles GmakGs
Used StartDate Quit Date s Tobaccos Tobacco
Status QuitDate
as of Former Smoker ProýIded 09 P.L: :.010 .. . :. . .NevéM
1/11/2016 . . . . 0sed
Alcohol Use Alcohol Use Source Drirks Week Alcohol/Wk Comments
as of 1/11/2016 Yes .. Provider 5 Cans of beet 1-2.Shots.o0 .0- 62 0 oz .; .. . . ;
Use Drug Use Source Types Frequency Comments
Drug
as of 1/11/2016 tes . . Pio id,er. .:: . : .'. .à00. ..:...regieRëdise co ah
&ctäëÿ ast tna lirjän
Sexual Activity Sexually Active Source BirthContro Partners Comments
as of 1/11/2016 Yes. .. Prside .Cond.omEPilidOCR . Mafe.W :. .. M
Problem Listas of1/11/2016
lechemic leg 1/11/2016- Present
Entered by Sabrina Chan Look, NP
0 8.2:18 AM by S.abrinaChan I.oDK,.NP
OverviewSigned 1/H/
RIGHT
* (Principal)Thrortede!!am 1/10/2016- Present
Entered by JayantilalM Patel, MD
OverviewSigned #10/2010 9:42 PM by Jayantifa1MPatel,MD
Rt. Popliteal and below
Cardiac arrest V9/2016 - Present
.
.. .. ....... . ..-..-.
... ........... . .
. .. .... .....s
.. .-..
....... .... . ......,_.....
........,,. .-. ........ ......-....-
¬ , ......., ered by Sigr,eshÄMiga, MD
.........Ep
DM wfo compHcation type 1 1/9/2018-Present
. . . . . . .. . Entered by AnastasiosManessls MP
Adrenannsuff iciency, primary , 1/9/2010- Present
$/P R - of nerve and vessels
blopsy, malignant mass excision, Internal fixation w/bone cement, =perc"on 8/9/2015- Present
Entered by Alana C Hendrixson,PA-
C
AiÈal t y tÈro Es)rig ÖνΠÃ1Š-Ãe
Hypoglycemia 6/12/2012- Present
. . . ..............
..... . .. ~.....-
..s......s., .. .--....
. -. .....-._......... ....-.50Âere bLRgnald
.an
................... . ....,..............-................
......,. MD
Depression 12f20/2011-Present
Entered by CynthiaW Earlg,NP
OverviewSigned 12/22/2011 3:47 PMby Eve Walto, MD
Recent suicide gesture. Took intenticñal overdose of levimir due to guHt (deceiving her parents about
Generated on 7/19/2016 3:22 PM Page 4
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
2510 30th ave DANIELS,lVOlRE
. NOUD1 ASTORIA NY 11102 MRN: 2457615
. Sit)âi Entire Chart DOB: 1988, Sex: F
Adm: 1/8/2010, D/C: 1/11/2016
QUe9f$ . .
Problem Listas of1/11/2016(continued)
attending school).
Maiignant plfeochromeytoma 17/20Í1 -Pres n
Entered by RonaldTamler, MD
OverviewAdderufum12/1/201S 9:51 PM by EvaWalte, MD
Is not detected usual MBG scans, Wact:† to resection 2015
by hip, s/p
Vitarnin D deficiency 12/24/2010- Present
Entered by RonaldTamler, MD
Overview Signed12/20/2011 9:31 PM by Eva Walte, MD
Vitamin D level=16.7 on 12/11.
Type 1 diabetes me(Gtus, uncontrolled 12/14/2009- Present
.,. ....-,.....--,s..
. ..-..s . ..-........s..... .
..... .. -. .... .
.......,¬.,,~.....s-.., ..........,.. .
.........--.. -..EtteJed.,by.Cynt
-.. ..-,.... Esi I
Anx1ety 8/6/2009- Present
... ... ................... ........ .................
,............ . Egg[gd,,byBo
.. .........,-.... . . . ..,- ,,,.-,......,-.-.. . .. .........,,,-...,,...
. ~......-. d Tamler3h/
...., .. . .................
Drug abuse in remiselon Unknown-Present
Entered by RonaldTamler, MD
OverviewAddendum12/22/2011 3:48 PM by EvaWalte, MD
Alcohol and cocaine. Positive tox screen 12/2011. Back in Rehab program day treatment
I rrent) inÔt
Encounter for long-term n use E/23/20Ò8 P3ent
. . . .. . . . ... . . Enteredby RonaldTamter, MD
Adrenal insufficiency 11/t8/2008 - Present
- .....
. . , .
....... .
... ... . . .. s.. -
. .....
..., ......... ..- .. . .. . .....
. --s....
. ..3 d Tarnler
red by Ron D
Diabetic neuropathy 10/17/2000 - Present
.. . . . . . .Enteredby RonaldTamler MD
Extra-adrenal paraganguoma . 10/3/2008- Present
Enteredby EvaWa(te, MD .
OverviewAddendum7/11/2014 7:28 PM by EvaWalte, MD
Functional parageg"enerña (pheo) resected on 5/8/08 (leftside). Then recurrent lesions T7/8 in
thoracic area, resected 9/08.
Single kidney Unknown-Present
Entered by EvaWalte, MD
OverylewAddendum10/3/2008 8:50AM by Eva Waite, hilD
Due to recurrent Wilrn's tumor, Residual kidney has had resection x 2
Beckwith-Wledemann syndr=-;c Unknown-Present
Entered by EvaWalte, MD
OverviewAddendum 10/3/2008 8:51 AMby Eve Waite, MD
herni hypertrophy and neonatal hypoglycemia requiring partial pancreatectoray
Wilm's tumor (nephroblastoma) Unknown-Present
Entered by EvaWaits, MD
OverviewAddendum 9/10/2000 4:41 PM by EvaWaRe.MD
s/p surgery x3, chemo
Diabetes mellitus associated with pancreatic disease Unknown-Present
..s................ .. .......
........s....... . ....-... . . .........., -.. -,-.....
.......-....-,.. ...
......-,........ .. .._..,..., .
.......,-,,--..,
Jpted by E ligyp,,,,,,.
RESOLVED:Sepsis 11/7/2016-12/1/2010
Entered by Tenzin Notyang
. . .. . ., . , . .. . . . . . . .. . . . Resolvedby Eva Walte, MD .
RESOLVED:Acute gastroenteritis 6/27/2014- 7/11/2014
Entered by KathleenKaranlkolas3MD
RESOLVED:Tumor, metastailc 5/1Al2013-12/1/2016
Entered by Ronaki Tamler, MD
RESOLVED:Dysphagle 4/10/2012 7/11/2014
Entered by LeanneGolders, SLP
.... ...
. .....,,s.-,. . s. ... . ...
s ......,,,.,. .-.. ....
.m.... . .. s.
...- .. , R.esojv.efby. Eva Wajte
... ... .. . ...........s.
RESOLVED:Tracheal stenosla 12/22/2011-12/1/2015
Entered by Mark Shapiro, MD
Resolved by Eva Waite, MD
OverviewSigned3/20/2012 4:39 PM by Eva Waite, MD
S/p tracheal reconstruction 3/2012 at Mass General.
ÈtE OLVED:Url arylrect iniec
n ÑŸ350ÔE3ÊÒE201
Entered by RonaldTamler, MD
Generated on 7/19/2016 3:22 PM Page 5
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018
NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019
2510 30th ave DANIELS,lVOlRE
MODI ASTORIA NY 11102 MRN: 2457615
Sinéd EritireChart DOB:M1988, Sex: F
()geng Adm: 1/8/2016, D/C: 1/11/2016
Problem Ust as of1/11/2016(continued)
. . . - .. --· . - . . . NotedL Reselved . . '.
.... .. . ....
.. . . .... .. ....
.... ...... .- _,...........
, . ... . .
... ..... .. .... . .......Resg|yedby EyajA(alt
.... ............. . D
RESOLVED:Abdominal pain 5t12/2009- 6/29/2012
Enteredby RonaldTamler, MD
- . .. - . .. ....
.. .... .. .. ... ..... . .. _,..........,_
.......... .... ..-... .
.. Resolv,,e(I
by,.§va
.................. He,MD,...
RESOLVED:Acute abdominalpain . 5112/2009- 3/20/2012
Enteredby RonaldTamler, MD :
. . . .. .
. . . . .. . . . . . Resolvedby Eva Walte, MD
RESOLVED:Back pain . 10/17/2008- 3/20/2012
Enteredby RonaldTamlet, MD
. . ... ......................-- .. . ... ,..,.,,,,,.,,,.................
. . .. ...,.... ...,... . .......,,,..,............,. ..................,,,3PSO.lve
. ......,,,.....,,,-....
-. Eveye, MD....,,.
RESOLVED:hypertension Unimown-3/20/2012
Enteredand resolved by Eva Waite,
RESOLVED:.Cardinoabnormality 9/10/2008-0129/2008
Enteredand resolved by Eva Waite,
MD
RESOLVED:Pfeuralnodule 7/2S/2008- 10/3/2008
Enteredand resolved by Eva Walte,
MD
OverviewAddendum 9/29/2008 7:58 PM by Eva WaKe,MD
2 pleural based lesoin at t7/8 level. Possible 3rd lesion in right inferiorchest.
Resected 9/08-found to be paragangiloma x2.
. . . . ....
.. .. . ,.. .. . . ., . . .
Preview
FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 EXHIBIT I FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 2510 30th ave DANIELS,IVOlRE Mount ASTORIA NY WI02 MRN: 2457615 SiTMi Entire Chart DOB: W1988, Sex: F QUMfiS Adm: 1/8/2016 D/C: 1/11/2016 VisitID . QB370136882 Patient%mmyhles Najne fatient . ser. 001 . '. :Address ·! Phone .: '-:.: Daniels,Ivoire Female 1988 4540 CENTERBLVD 718.808-9367(Home) APT 2501 917-734-8699(Moblle) LONGISt.ANDCITYNY 11109 PatientEthnicity& Race _,_ hnic d|L_: ; . ent Race .. Non-HIspanic Caucaslan(White Admission Information Arrival Dale/Time: 01/08/2018 6:27 PM Admit Date/Time: 01/08/2018 9:16PM (P Adm. Date/Time: 01/09/2016 2:39 AM AdmissionType EmergencyDepartment Pointof Odgin: Non-healthcareFacility Admil Category: . None Meansof Anival: 911 Ems GeneralMedicine· N/A Primary SeNice: SecondarySeivice: TransferSource: None ServiceArea: Mount SinalQueens Unit: Maq 6 East - Inpatient Admit Provider None Attending Provider: NathanielP Bonfanti,MD Referring Provider MolzA Hamdant,MD Discharge Information - - DIséhidgedestIriiÈI6ñ " isWaigaDätedirrie Disaliarge DWi , : :.: ÛDiiigsagleAnciyider. .½'.r I,hiit :. : 01/11/2016 1:39AM TransferredTo ShortTerm Msh OtherCare Center None . Msq 5 East Institution Events ' to6rn/Bed.·- Datemine -. Everit Pt Class - : Unit 8Wr2. :. ..01/.10/182 33 Transfer O inpatlant MSQ EICU 600/03 Genom,jyedicine 01/10/162233 Transfer In Inpatient MSQ 5 EAST 609/01 GeneralWIedicine 05/11/100139 Discharge fnpatient MSQ 5 EAST 609/01 GeneralMedicine Initial Time Seen by ED Provider - - Date/Brne Event ... thier , .. .:- : Gointrients - . r -. 01/D8/161841 Provider BONFANTI,NATHANIEL ED Event Log .. batti/Time Evei ser. .·; fle .....u..........e 01/D9/160239 Patient Departure INTERFACE,KEANEADT Triggeredfrom one of the ED end of v sil events. Allerplesas of 1/11/2016 Reviewed On: 1/11/2016By; OIga Prvstune, MD sAllerden . ..E. . . : Noted actfan.Ty .. eac s .·: FentanyI Citrate 01/10/2016 Unknown .. 8. alle Fe9,tlanedthat pty to Fentanyl .., . _,,_ ,,_ Fontanyl 09/29/2008 HIves, Itching severeItchin Losartan 05/11/2013 Other ye¼igyg endedness .... .. Novolog [Insulin Aspart] 06/06/2012 HIves Imn,üïi:zâtbraand IV Meds Name . . · .. Date base : Rodt0. àIte. :P : . INFLUENZAVACCINE Sun Nov 8, 2015 12:25 PM 0.5 mL Intramuscular Rightarm .. ®M.a to RIce .,,.. INFLUENZAVACCINE 01/09/13 0.5 rnL intrainuscular Left arm ..0)ven By: FemAllen RN INFLUENZAVACCINE Wed Oct 7, 2009 3:30 PM U.5ml Intramuscular Left deltod INFLUENZAVACClNE Fri Nov 7, 2008 s;01 PM 0.5 mi intramuscular Right arm . . ..GivenBy; CrjstinaRoberts ... Pneumececce! Vaccine 23-VALENT Sun Nov 8, 2015 12:29PM 0.5 mL Intmmuscular Left arm . ....e Be_me.(dita RI TuberculIn PPD intradermal Test Thu Apr 14, 2011 3:11 PM 5 TU Intraderrnal Leftventrical forearm Given ByEise Nieves 0 Generated on 7/19/2016 3:22 PM Page 1 --- FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 2510 30th ave DANIELS,IVOfRE i Moultit ASTORIA NY 11102 MRN: 2457615 Sinal Entire Chart DOB:M1988, Sex: F Adrn: 1/8/2010, D/C: 1/11/2016 Medical Past Medical History Date Comments Source as of 1/11/2016 Prernaturhy[PO .30] 3ro ille Nesidioblastoma [D13.7] s/ppartialpancreatectomy Provider Beckwith- ViedefriannsyhdrÖiñé [Q 87c3] 9 mo öf aje cltphy..: . .. rovlyler heini·hph Wilm's tumor (nephroblastoma) [C64.9] 18 month s/psurgery x3,chemo Provider DiatietésmÃIlRus:asso,clatidWith pahoreef 1::7. E.:. . . .. . . Proviiler I .disease[Ei1.6sCK86.9] -. .: . . ; . hypertension [110] 2004 Provider gingivalhyperplasia.IM8700/0 (ICD-9 CM)] . . Providêt Bipolardisorder,unspecified[F31.0] 4/06 Provider ¡ ADHD . - .. : Pevider Microscopic Hematurla 2/12/04 kidney stones Provider .. Pheochromocytoma NOS (M8700/0 (ICD-9- .5/8/06 paraggreudhi ;: f.ä&enah Provips - · · · CM)J . . .: . .. gland,leftside : . Adrenal [E27.40] insufficiency . 11/18/2008 . Provider Åbdominal painIri10.9] . 5/1.2)2009 : .... ProWÚ r Acute abdominal pain[R10.0] 5/12/2009 Provlder S/P exploratorylaparotornyZ98.89] Provider i qurgeryjZ9B .kride 89] . ... leif rõvidef . Paraganglloma [D44.7] Provider depiession.[F)2 ] . . . . . . . roüldi Anxiety [F41.9] , Provider ùicideaveVnptIT14 9 ] ; . . :. γroÿÏd Tracheal stenosis[J39 8] 3/2012 Provider Esse i hypéneñsion I†priniiny) [H0] resolved ; 1P ovii Sinusltis[J32.G] Provider spWilnïs dmor [Z88 8 . . :. PröWS Diabetes [E11.9] secondary to removal of Provider pancreas Other' ecifiéddisogerlitkidneýäiáIñW : .. .Yji:. : Prov'1der:Q- . S/P R acetabufum biopsy,malignant mass 6/9/2015 Provider excision,intemalfixationw/bone cement, explorationof nerveand vessels [Z98.89] ÚiRE.(systEWEinfdnima ðifre 50y e 1920 o Q ov $41..9]. - . . $il. . syndroms) . Partiherit Negatives . . : bate Nete0 . Co ninerite oûÑéÏ Othér Specifiedinfedti.oufandp asiÈc . 5/12/20{ . . iBvid diseases [B995 B89] .... Anemia, unspecified [D04,9] 5/12/2015 Provider Unsfiecified asthma 93190)[J45 909] 5/12/2015 . . . . Piovide Cirrhosis without of liver mention ofalcohol 5/12/2015 Provider [K74.60] Other.arid.uns cÏfiedcoagulaUon dèfees 5/f2Ï200 . O EldeÝ [D68.9] . . . .. Chronic airway obstructiorhnotelsewhere 5/12/2015 . Provider classified[J44.9] Iritecerebrallemorrhagell61 9]. .5/12/2bi5 . ! . tW 8er Cerebral thrornbosiswithcerebral infarction 5/12/2015 Provider [i63.30] \/Iral hepatihs,Byithoi t mention of,hepatic,- . . - . Provi§gr - _ 5/12/2015, i. '' '- - . :- coma'pcute"or unspecified without mention of , hepåtitisdelta[B16.B] Unspecified hepatitis viral C without hepatic 5/12/2015 Provider coma [B19.20] fidmajiEnidpodefig ertop rus (RjŸ)dise sQRk/2ù15 . üÏd r : Generated on 7/19/2016 3:22 PM Page 2 FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 2510 30th ave . DANIELS,NOIRE Mond ASTORIA NY 11102 MRN: 2457615 Sinai Entire Chart DOB: 1988, Sex: F DUGeD$ Adm: 1/8/2016, D/C: 1/11/2016 Obstructivesleep apnea (adult)(pediatric) 5/12/2015 Provider [G47.33] Glaucorria[H40;9] . 5/12/2016 . · 1 - . ffovlyei ... Unspecifiedtransientcerebral ischemia 5/12/2015 Provider [G45.9] Autoniatip implantablecardiac denhyaor ir 5/12/2918 .rd9lder situ[Z95c810]: :. .. . -- : .. . . Coronary atherosclerosisofüñspecHied type of5/12/2015 Provider vessel, nativeor graft [I25.10] Unspecified ccñg6ñnd anornaly affieert 5/12/2015 .Provider Congestive heartfailure,unspecified[I50.9] 5/12/2015 Provider - 5/I2/2015 :. .: . Old. rnyocardialInfarction [|25.2]. . - . -. Brovider . ; Surgical Past SurgicalHistory Laterality Date Comments as of 1/11/2016 HX PATENT. DUCTUS NRTER U . . . .. .. . . . . . . - C/GATIÒN{SHXž69E .;. LENGTH/SHORT LEG/ANKL TENDON MULTI 12 yr left [27686] TOTAL: NÈ! A5ECTÖMV 4 j8 mo Nl6nteÏÎore . HX PARTIAL NEPHRECTOMY [SHX414] ag4 yr and 7 yr. due to wilrns, left kidney HX BRÈÄST REDUdTION SURGÈi]Y [äHX8] 4/0 . : ü iÏp{eiafleff . WnõVed HX BREAST ENHANCEMENT SURGERY 4/04 unilateral [SHX7] . right HX PANCREAS SORGERY :-:- . · . . .hecñ is :. . .P __.0 T [SHX731] HX ADRENAL GLAND SURGERY [SHX544] 5/8/08 phoo Pertsemilids surgeon FORIEGN BODY.QR F.IBRIN DEiPCSIT . :. : . - mgdiqptil a . HX KNEE SURGERY [SHX244] left arthroscopy BRONCRO OPY.[600604] . /31/12 to 2/2/12 . rëpdatéd RECONSTRUCT WINDPIPE [31780] 3/2/12 Mass General Hospital, Boston HEREDITARY PARAGANGLlOMA- 3/2013 r¼cu TenL " " PHEOCHROMOCYTOMA - GENETIO . .. . __ . .. - [102423] . THROMBECTOMY / EMBOLECTOMY 8/5/2013 rightaxillary ¡ AX1LLARY [SUR1352] artery thrombus ABliDÑlEN SUlWE'RY PROC INIïSTED . .4. .. . . . .., . . .. . . .. ....., .- .., . . . .. ..,... - . ... . .. . ... ... Problem Relation Name Age of Onset Comrnents Source Family ; Generated on 7/19/2016 3:22 PM Page 3 FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 2510 30th ave DANIELS,IVOlRE OH ASTORIA NY 11102 MRN: 2457615 Sinai Entire Chart DOB: W1988, Sex: F Adrn: 1/8/2016, D/C: 1/11/2016 as of 1/11/2016 Glaucoma ..: Family -. : . . . . . ,.i Prayfdep.. .. . .. - Ï ÏSSOry .. Nega6ve for. . . Diabetes Mellitus Family Provider History Negativefor Hypertendon · Fainlly . . ,,' . Provider ' Negativefo O er Eye Disease Family Provider History Ne ativefor Asthma . . Sister . . . . . Provider . Ca ncer Brother bileduct Provider cancer Cancer Mother all Providef. · bládderi Tobacco Use Smoking Status Source Types Packs/day Years Camments Smoking Smoking Smokeles GmakGs Used StartDate Quit Date s Tobaccos Tobacco Status QuitDate as of Former Smoker ProýIded 09 P.L: :.010 .. . :. . .NevéM 1/11/2016 . . . . 0sed Alcohol Use Alcohol Use Source Drirks Week Alcohol/Wk Comments as of 1/11/2016 Yes .. Provider 5 Cans of beet 1-2.Shots.o0 .0- 62 0 oz .; .. . . ; Use Drug Use Source Types Frequency Comments Drug as of 1/11/2016 tes . . Pio id,er. .:: . : .'. .à00. ..:...regieRëdise co ah &ctäëÿ ast tna lirjän Sexual Activity Sexually Active Source BirthContro Partners Comments as of 1/11/2016 Yes. .. Prside .Cond.omEPilidOCR . Mafe.W :. .. M Problem Listas of1/11/2016 lechemic leg 1/11/2016- Present Entered by Sabrina Chan Look, NP 0 8.2:18 AM by S.abrinaChan I.oDK,.NP OverviewSigned 1/H/ RIGHT * (Principal)Thrortede!!am 1/10/2016- Present Entered by JayantilalM Patel, MD OverviewSigned #10/2010 9:42 PM by Jayantifa1MPatel,MD Rt. Popliteal and below Cardiac arrest V9/2016 - Present . .. .. ....... . ..-..-. ... ........... . . . .. .... .....s .. .-.. ....... .... . ......,_..... ........,,. .-. ........ ......-....- ¬ , ......., ered by Sigr,eshÄMiga, MD .........Ep DM wfo compHcation type 1 1/9/2018-Present . . . . . . .. . Entered by AnastasiosManessls MP Adrenannsuff iciency, primary , 1/9/2010- Present $/P R - of nerve and vessels blopsy, malignant mass excision, Internal fixation w/bone cement, =perc"on 8/9/2015- Present Entered by Alana C Hendrixson,PA- C AiÈal t y tÈro Es)rig ÖνΠÃ1Š-Ãe Hypoglycemia 6/12/2012- Present . . . .............. ..... . .. ~.....- ..s......s., .. .--.... . -. .....-._......... ....-.50Âere bLRgnald .an ................... . ....,..............-................ ......,. MD Depression 12f20/2011-Present Entered by CynthiaW Earlg,NP OverviewSigned 12/22/2011 3:47 PMby Eve Walto, MD Recent suicide gesture. Took intenticñal overdose of levimir due to guHt (deceiving her parents about Generated on 7/19/2016 3:22 PM Page 4 FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 2510 30th ave DANIELS,lVOlRE . NOUD1 ASTORIA NY 11102 MRN: 2457615 . Sit)âi Entire Chart DOB: 1988, Sex: F Adm: 1/8/2010, D/C: 1/11/2016 QUe9f$ . . Problem Listas of1/11/2016(continued) attending school). Maiignant plfeochromeytoma 17/20Í1 -Pres n Entered by RonaldTamler, MD OverviewAdderufum12/1/201S 9:51 PM by EvaWalte, MD Is not detected usual MBG scans, Wact:† to resection 2015 by hip, s/p Vitarnin D deficiency 12/24/2010- Present Entered by RonaldTamler, MD Overview Signed12/20/2011 9:31 PM by Eva Walte, MD Vitamin D level=16.7 on 12/11. Type 1 diabetes me(Gtus, uncontrolled 12/14/2009- Present .,. ....-,.....--,s.. . ..-..s . ..-........s..... . ..... .. -. .... . .......,¬.,,~.....s-.., ..........,.. . .........--.. -..EtteJed.,by.Cynt -.. ..-,.... Esi I Anx1ety 8/6/2009- Present ... ... ................... ........ ................. ,............ . Egg[gd,,byBo .. .........,-.... . . . ..,- ,,,.-,......,-.-.. . .. .........,,,-...,,... . ~......-. d Tamler3h/ ...., .. . ................. Drug abuse in remiselon Unknown-Present Entered by RonaldTamler, MD OverviewAddendum12/22/2011 3:48 PM by EvaWalte, MD Alcohol and cocaine. Positive tox screen 12/2011. Back in Rehab program day treatment I rrent) inÔt Encounter for long-term n use E/23/20Ò8 P3ent . . . .. . . . ... . . Enteredby RonaldTamter, MD Adrenal insufficiency 11/t8/2008 - Present - ..... . . , . ....... . ... ... . . .. s.. - . ..... ..., ......... ..- .. . .. . ..... . --s.... . ..3 d Tarnler red by Ron D Diabetic neuropathy 10/17/2000 - Present .. . . . . . .Enteredby RonaldTamler MD Extra-adrenal paraganguoma . 10/3/2008- Present Enteredby EvaWa(te, MD . OverviewAddendum7/11/2014 7:28 PM by EvaWalte, MD Functional parageg"enerña (pheo) resected on 5/8/08 (leftside). Then recurrent lesions T7/8 in thoracic area, resected 9/08. Single kidney Unknown-Present Entered by EvaWalte, MD OverylewAddendum10/3/2008 8:50AM by Eva Waite, hilD Due to recurrent Wilrn's tumor, Residual kidney has had resection x 2 Beckwith-Wledemann syndr=-;c Unknown-Present Entered by EvaWalte, MD OverviewAddendum 10/3/2008 8:51 AMby Eve Waite, MD herni hypertrophy and neonatal hypoglycemia requiring partial pancreatectoray Wilm's tumor (nephroblastoma) Unknown-Present Entered by EvaWaits, MD OverviewAddendum 9/10/2000 4:41 PM by EvaWaRe.MD s/p surgery x3, chemo Diabetes mellitus associated with pancreatic disease Unknown-Present ..s................ .. ....... ........s....... . ....-... . . .........., -.. -,-..... .......-....-,.. ... ......-,........ .. .._..,..., . .......,-,,--.., Jpted by E ligyp,,,,,,. RESOLVED:Sepsis 11/7/2016-12/1/2010 Entered by Tenzin Notyang . . .. . ., . , . .. . . . . . . .. . . . Resolvedby Eva Walte, MD . RESOLVED:Acute gastroenteritis 6/27/2014- 7/11/2014 Entered by KathleenKaranlkolas3MD RESOLVED:Tumor, metastailc 5/1Al2013-12/1/2016 Entered by Ronaki Tamler, MD RESOLVED:Dysphagle 4/10/2012 7/11/2014 Entered by LeanneGolders, SLP .... ... . .....,,s.-,. . s. ... . ... s ......,,,.,. .-.. .... .m.... . .. s. ...- .. , R.esojv.efby. Eva Wajte ... ... .. . ...........s. RESOLVED:Tracheal stenosla 12/22/2011-12/1/2015 Entered by Mark Shapiro, MD Resolved by Eva Waite, MD OverviewSigned3/20/2012 4:39 PM by Eva Waite, MD S/p tracheal reconstruction 3/2012 at Mass General. ÈtE OLVED:Url arylrect iniec n ÑŸ350ÔE3ÊÒE201 Entered by RonaldTamler, MD Generated on 7/19/2016 3:22 PM Page 5 FILED: QUEENS COUNTY CLERK 07/18/2019 11:35 AM INDEX NO. 704658/2018 NYSCEF DOC. NO. 72 RECEIVED NYSCEF: 07/18/2019 2510 30th ave DANIELS,lVOlRE MODI ASTORIA NY 11102 MRN: 2457615 Sinéd EritireChart DOB:M1988, Sex: F ()geng Adm: 1/8/2016, D/C: 1/11/2016 Problem Ust as of1/11/2016(continued) . . . - .. --· . - . . . NotedL Reselved . . '. .... .. . .... .. . . .... .. .... .... ...... .- _,........... , . ... . . ... ..... .. .... . .......Resg|yedby EyajA(alt .... ............. . D RESOLVED:Abdominal pain 5t12/2009- 6/29/2012 Enteredby RonaldTamler, MD - . .. - . .. .... .. .... .. .. ... ..... . .. _,..........,_ .......... .... ..-... . .. Resolv,,e(I by,.§va .................. He,MD,... RESOLVED:Acute abdominalpain . 5112/2009- 3/20/2012 Enteredby RonaldTamler, MD : . . . .. . . . . . .. . . . . . Resolvedby Eva Walte, MD RESOLVED:Back pain . 10/17/2008- 3/20/2012 Enteredby RonaldTamlet, MD . . ... ......................-- .. . ... ,..,.,,,,,.,,,................. . . .. ...,.... ...,... . .......,,,..,............,. ..................,,,3PSO.lve . ......,,,.....,,,-.... -. Eveye, MD....,,. RESOLVED:hypertension Unimown-3/20/2012 Enteredand resolved by Eva Waite, RESOLVED:.Cardinoabnormality 9/10/2008-0129/2008 Enteredand resolved by Eva Waite, MD RESOLVED:Pfeuralnodule 7/2S/2008- 10/3/2008 Enteredand resolved by Eva Walte, MD OverviewAddendum 9/29/2008 7:58 PM by Eva WaKe,MD 2 pleural based lesoin at t7/8 level. Possible 3rd lesion in right inferiorchest. Resected 9/08-found to be paragangiloma x2. . . . . .... .. .. . ,.. .. . . ., . . .