Preview
iD: AR ONX OUN NK 0:40 DV INDEX NO. 21169/2011E
NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021
EXHIBIT II
INDEX NO. 21169/2011E
NYSCEF DOC. NO. 246 RECEIVED NYSCEF: 10/25/2021
= Keais
mums RECORDS RETRIEVAL
IN RE: Kelley Phillips
STYLE OF CASE
PERTAIN TO Kelley Phillips
FROM Palm Bay Hospital (Medical Records)
DELIVER TO Yvonne Hyams
Havkins Rosenfeld Ritzert & Varriale-59176
114 Old Country Road Suite 300
Mineola, NY 11501
626030
CLIENT MATTER NO.
CLAIM NO. 626030-PHNP12040626030-001-BI
11190-305
CASE NO.
COURT:
Order No. 152247.089
Ui IOAN
l= RONX OUN NK 0:40 DV INDEX NO. 21169/2011E
NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021
& res
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
{This form has been approved by the New York State Department of Heaith]
OCA Official Form No. 960
Patient Name Date of Birth ‘Social Security Number
KELLEY PHILLIPS _
Patient Address
£700 Mango Street NE, Palm Bay FI. 32905
1, o my authorized representative, sequest that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Role of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), [understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENY, except psychotherapy notes, nd CONFIDENTIAL HIV* RELATED INFORMATION only if] place my initials on
the appropriate line in Hem 9a), in the event the health information described below includes any of these typcs of information, and 1
initial the line on the box in Hem 9a), I specifically authorize release of such information to the person(s) indicated in tem 8,
2. Uf Lam authorizing the release of HIV-related, elcohol or drug veatment, or mental health treatment information, the recipient is
prohibited from redisclosing such information without my authorization untess permitted to do so under federal or staic law. 1
understand that I have the right to request a list of people who may receive or use my HlV-related information without authorization. If
J experience discrimination because of the release or disclosure of HIV-related information, 1 may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450, These agencies are
responsible for protecting my rights,
3. have the sight to revoke this authorization at any time by waiting to the health care provider listed below. -I understand that I may
ravoke this authorization except to the extent that action has already been taken based on this authorization.
4, 1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization ofthis disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2}, and this
redisclasuse may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY GR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 {b).
7. Name and address of health provider or entity to release this information:
Palm Bay Hospital, 1425 Malabar Road, NE, Palm Bay, FL 32907
8. Name and address of person(s) of category of person to whom this information will be sent:
Havkins Rosenfeld Ritzert & Varriale, LLP, 1065 Avenue of the Armericas, Snite 800, New York NY 10018
9(a). Specific information to be released:
O Medical Record from (inser date} 10 (insert date}
@ Entire Medical Record, including paticnt histories, office notes (except psychotherapy noles), test results, radiology studics, films,
referrals, consults, bitling records, insurance records, and records sent to you by other health care providers.
C) Other: Include:
oo (fadicate by Initaling)
AlcoholfDrug Treatment
Mental Health Information
Authorization (o Discuss Health Information T¥-Related Taformation
(&) 0 By initiating here Tauthorize
Initials ‘Name of individual health care provider
to disouss my health information with my attomey, or a governmental agency, listed here:
{Atomey/Firm Name or Gavernmental Agency Name)
10. Reason for rcleasc of information: 11. Date of event on which this authorization will expire:
G At request of individual MARIE MORROW
Other: Litigation end of litigation ROTARY.
12. {fnot the patient, name of person signing form: 13." Authority to sign on beha
of lf
WaveHt aqgossat 9
Michael A, Rose Power of Attorney
AU it on this form, been compicted and my questions about this form have been answdmedoknras
hitdldtipre
WoveRaDUF NGG
e fh
cepy form,
‘Signature of patient or representative authorized by law.
out spi
* Human anwnedeficieney Virus that causes AIDS. The New Yerk State Public Health Law protects information which reasonably could
identify someone as having i37V symptoms or infection and information regarding a persun’s tomiacts,
Hs 4a weooi4d]
BRON OUN 40 INDEX NO. 21169/2011E
NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021
Table of Contents
Image Page No.
001-ER-7-12-12
002-ER-7-13-12 77
003-A DMIT-9-6-12 137
004-DISCHARGE-SUMMARY 188
005- HISTORY -A ND-PHY SICAL 190
006-PROGRESS-NOTES 191
007-PHY SICIAN-ORDERS 195
008-MEDICATIONS 215
009-VITAILS 237
010-NURSES-NOTES 264
011-ER-4-25-13.... 354
012-ER-7-23-13 394
013-ER-11-20-13 447
014-OP-TESTING-3-19-14 492
015-OP-TESTING-3-25-14 496
016-ER-5-31-14. 499
017-ER-8-2-14 558
018-ER-10-25-14 611
INDEX NO. 21169/2011E
NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021
oe
‘Ex PECTED ADIT DTM |
(PATIENT NUMBER: SEX] MAS [RAGE [ADM BY [FIN, CLASS|MEDICAL
RECORDS NUMBER "ADMISSION DATE & TE
H1219490849 PER - FILS{i LCs £ HCCO402647 07/12/12 1632
PATIENT NAlME AND ADDRESS PATIENT EMPLOYER (aypMeLOYED ‘DISCHARGE DATE & TIME,
PHILLIPS, KELLEY ANN UNEMPLOYED O7/12/12 10:05)
1700 MANGO ST NB (221) 298-0044 {H)
321) 298-044 (C)
PALM BAY, FL 32805 , FL
REGISTRATION ORIGH SERVICE CODE DESCRIPTION INFO. PRIMARY LANGUAGE [LIVING WiLL] PATIENT CLASSIFICATION
e PEA EDS EMERGENCY SERVI | YES GLISH NO
{i ouirinc PavSIonN 527056 JATTENDING PHYSICIAN 322056 PRIMARY CARE PHYSICIAN
FE|AGOSTO DIAZ, EDIL J JAGOSTO DIAZ, BDIL J BEAT, SYED B
a. [BIRTHDATE RSE BIRTHPLACE, REGION [CHURCH
34 FL NG INO CHURCH PREFERENCZ 1
[PREVIOUS ADIAISSION NAME, PREVIOUS ADIT DATE [ADMISSION SCURCE [ARRIVAL MODE.
PHILLIPS, KELLEY ANN 08/25/12 PED NON HEALTHCARE FAC SELF
|GUARANTOR NAME AND ADDRESS: SELF EMPLOYER
PHILLIPS, KELLEY ANN KINEMPLOYED
1709 MANGO ST NE
(321) 258-0044
| PALM BAY, Fh 32505 ’ PL
NEXT OF KIN MOTHER: ADIT TNS DIAGNOSIS.
MULTIPLE CCMPLAINTS
| PHILLIPS, EILEEN PRIMARY DIAGNCSi
< 1790 MAKGO ST NE (221) 789-3523 SECONDARY DIAGNOSIS:
a(¢| PALM BAY, FL 32905
CORD#
= C0352668
ha PRIMARY SECONDARY
S| pout Spit coud GPE
cRT: SQLH Facesheet_Cl 2 »FEQO1420 Printed by FormFast at Q7/1Z/2912 2246
DATE 12/23/2015 PRINTED BY: 14332277
ON OUN 0:40 INDEX NO. 21169/2011E
NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021
Print Name {Ke jo, KM es,
Social Security “aaa
fon MAMA lergivt Cxre.
Reason for Visit Yes
V: Jet Heo] HA [ABD
LOCAL DOCTOR
Date of Birth Shot Sua A
440005 PEK 7100, BOK, 12/01
DATE 12/23/2015 PRINTED BY: 140332277
l= RONX OUN NK 0:40 DV INDEX NO. 21169/2011E
NYSCEF BOC. NO. 246 RECEIVED NYSCEF 10/25/2021
Palm Bay Hospital Emergency Departrient MRN: H000402647 Acct #: HI2194N0R49
1425 Malabar Rd. NE 2 434-8015
Palm Bay, FE. 32907 ment Sheet Sex: F
‘Age: 34 DOB: QB erone: 321-298-0044
Name: PHILLIPS, KELLEY ANN
Address: 1700 MANGOST NE, PALM BAY, FL, 32905,
Room Number: PR-ETL-PFI ie
Complaint: Abdominal pain Nausea Vomiting ‘Acuity: Urgent
Arrival Date/Time: 07/12/2012 16:31 Insurance: i
Arrived by: Self MD Referral: No
PCP: Bhat, Syed Emergency Physician: Agosto Diaz, Edil
Accompanied by: No one PA/ARNP:
Treatment PTA: Triage Nurse:
Past Medical ©
Primary Language: English
Pain Goal: infection Control Alert: Unknown
Wei $2.5 kg Tetanus History: Less than 5 years
Heigt 167.6 em UMP Date:
Presenting Medications Allergies
Ar Cay et vi a
Ambient 10 mg oral tablet -- 1 orally once a day (at bedtime) gabapentin ~ Gakuown
Cymbalta 60 mg oral delayed release capsule ~ 1 orally once a day Other -- Other
(at bedtime)
tizanidine ~- Syncope; Dizziness
Lyrica 225 mg oral capsule -- 1 oraliy 2 times a day
trazodone -- Unknown. j5
morphine extended release -- 30 milligram(s) orally every 8 hours fo
Percucet 10/325 oral ublet - tab(s) orally 2 times a day as needed
phentermine 37.5 mg oral capsule — 1 cap(s) orally once a day
Vital DS
mn om ee rh wt Butte
12 16-41 97ST 132/94 2 16 100 16:41
07712412 21:19 125/61 60 16 10a 21:19
Disposition Information
Primary Diagnosi Abdominal pain - unspecific site ‘Valuable Farm Completed: No
Secondary Diagnoss Vomiting ~ adult Family Notification:
lReport Catled by: / Report Given Yo:
Disposition: Home Discharge Date: 07/12/2012 22:05
IPrescriptions: Ultracet 37,5 mg-325 mg oral tablet,
famotidine 20 mg oral cablet, Zofran 4
mg oral tablet
ED Summary Report
TA3/2012 9:06:27 AM paliRNFIDENTI
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Palm Bay Hospital Emergency Department MRN: 000402647 Acct ff. H1219400849
1425 Malabar Rd. NE 321-434-8085
Palm Bay, FL 32907 Assessment Sheet Sex: F
Age: 34 DOB: 4/24/1978 Phone: 321-298-0044
Name: PHILLIPS, KELLEY ANN
Address: 1708 MANGO ST NE, PALM BAY, FL 32905
Room Number: PR-EI-PFOS-1
Orders
Laboratory/Blood Bank Orders
PHILLIPS, KELLEY ANN - 100040264744 1219400849
ICBC FALZ2012 5:18:08 PM by Agosto Diaz, Edit 7A2/2012 6:33:18 PM
CMP 7112/2012 5:18:08 PM by Agosto Diaz, Edil ‘V12/2012 6:46:19 PM
HCG Qual 7/12/2012 5:18:08 PM by Agosto Diaz, Edit 7/12/2012 6:59:58 PM
Urinalysis 7/12/2012 3:18:08 PM by Agosto Diaz, Edil PA22012 $:41:41 PM
Meds and 1Vs Orders
PHIT.LIPS, KELT EY ANN - H000402647/H 1219400849
HY DROMOR phone Injectable 71272012 5:18:08 PM by Agosto Diaz, Edil FA2/2012 6:21:06 PM
Ondansetron Injectable 7/12/2012 5:18:08 PM by Agosto Diaz, Edit FAQ2032 6:21:07 PM
Ondansetron Injectable (232012 8:10:38 PM by Agosto Diaz, Edi) £2/2012 9:34:54 PM
Nursing Orders
PHILLIPS, KELLEY ANN - 1000402647/H1219400849
Satine Lock ED 7/12/2012 5:18:08 PM by Agosto Diaz, Edil FAB2012 6:21:07 PM
(02 ED 7/12/2012 5:18:08 PM by Agosto Diaz, Edil 7412/2012 6:02:11 PM
Pulse Ox Continuous ED WIZZ 5:18:08 PM by Agosto Diaz, Edit FA 22012 $:22:29 PM
Discharge to Home 7/12i2012 9:34:00 PM by Agosto Diaz, Edi} Not completed al timeof discherge
Radiology Orders
PHILLIPS, KELLEY ANN - H000402647/H12 19400849
[XR Acute Abdomen Series 7/12/2012 5:18:08 PM by Agosto Diaz, Edil 9412/2012 7:28:11 PM
ED Triage Document
T2/2012 43, 200 PM To 7/12/2012 4:41:00 PM
JSul-12-2012 16:41
Arrival Information
‘Time of Triage 16:42 0 Kelley, Dawn/RN
Language Spoken/tindersiood English O Kelley, Dawn/RN
Mode Of Arvivat: Self 4) kelley, Dawn/RN
ED Summary Report
VAZY2012 9:06:27 AM pa QNFIDENTH
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Pali Bay Hospital Emergency Department MRN: =HO00402647 Acct i: HI219400849
1425 Malabar Rd. NE 321-434-8015
Palm Bay, FL 32907 Asscesment Sheet Sex: F
Age: 34 DOB: 4/24/1978 Phone: 321-298-0044
Name: PHILLIPS, KELLEY ANN
Address: 1760 MANGOST NE, #ALM BAY, HL 32905
Room Number: PR-F1-PF05-
| Jul-12-2012 16:45
Arrival Information:
Means of Arrival [Ambulatory (0 kelley, Dawn/RN
[Accompanied by No one O kelley, Dawa/RN
Arrival Information
Chief Complaint [Abdominal pain 0 kelley, Dawn/RtN
Chief Complaint Nausea kelley, DawaiRN
Chief Comptaint Vomiting O kelley, Dawn/RN
Care Providers
Care Providers |Admitting, - EDPHYSICIAN, EDMD O kelley, Dawn/RN
Care Providers: |Attending, - EDPHYSICIAN, EDMD_ 0 kelley, DawnRN
Care Providers Stated PCP, Bhat, Syed 0 kelley, Dawn/RN
| Additional Comments
Additional Coraments patient sent from MIMA for further evaluation of =| kelley, Dawn/RN
Inausea and vomiting since Monday with abdominal
pain, PL also reports breaks out in sweats
Tringe Level
Triage Level Urgent ‘OD kelley. Dawna/RN:
Allergies
[Aliergies [gehupentin, Unknown 1 kelley, Dawna/RN
[Allergies Other, Other 0 Kelley, DawaiRN
Allcrgies rizanidine, Syncope; Dizziness 0 kelley, DawniRN
[Atergics trazodone, Unknown 0 kelley, Dawn/RN
Height - Weight
Weight: Ths Weight: Ths 482 0 kelley, Dawn/RN
Weight: kg Weight: kg R23 ky }O kelley, DawaiRN
Weight Type Actual ‘0D kelley, Dawa/RN
Height: inches of 1 kelley, DawnlRN
Height: em 162.6 0 kelley, Dawn/RN
Vital Signs;
Temperature F 197.5 degrees F 1) kelley, Dawa/RN
c 34.3 degrees C 0 kelley, Dawn/RN
Fenip Method Temp Method Orat ‘0 kelley, Dawn/RN
Heart Rate bpm 72 bpm 1D keltcy, Dawn/RN
Systolic Systolic: 132 mm Hie 1 kelley, Dawn/RN
ED Summary Report
FAYV2O12 9:06:27 AM paki FIPENTY54 3/2015 PRINTED BY: 1u332QQ%.
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Palm Bay Hospital Emergency Department. MRN. HO60402647 Acct #: HI219400869
1425 Malabar Rd. NE 321-434-8015
Palm Bay, FL 32907 A ment Sheet Sex: F
Age: 34 DOB: A24NSTS Phone: 321-298-0044
Name: PHILLIPS, KELLEY ANN
Address: 41700 MANGO ST NE, PALM BAY, BL 32905
Room Ninnher: PR-F1-PF!
| Jul-12-2012 16:41
Vital Sigos
Diastolic Diastolic 94 mm He 0 kelley, DawnRN
Resp Rate /min 16 ‘min }O kelley, Dawa/RN
SpO2 Sp02 % 100% O kelley, Dawn/RN
Pain
[Pain present? Pain present? Yes }O kelley, Dawn/RN-
Abdominal Pain Location Abdominal Pain \Epigastric kelley, Dawn/RN
Location
Pain Scale Tool Pain Scale Too! 0-10 0 Kelley, Dawn/RN
| Abdominal Pain Score Pain Score out of ‘len 7 AG O kellcy, Dawn/RN
Patient's Pain Goal out of Ten Patient's Pain AO 0 kelicy, Dawn/RN
Goal out of Ten
Abdominal Pain Oasct Abdominal Pain Onsct 4 0 kelley, Dawn/RN
- ays 0 kelley. Dawn/RN
Triage Avsessment
Ainway intact ‘0 kelley, Dawn/RN
Breathing No distress kelley, Dawn/RN
Circulation Adequate ‘O kelley, Dawn/RN
Neuro Awakevalert D kelley, Dawn/RN
Orientation Oriented x 3 0 Kelley, Dawa/RN
LMP
LMP [iun-21-2012 |e Kelley, DawniRN
ED Primary Assessment Document
7/12/2012 4:31:00 PM To 7/12/2012 5:09:00 PME
Jul-12-2012 17:09
Home Medications
Home Medications Ambien 19 mg oral tablet Maddox-Marlinez,
Kimberly/RN
Tlome Medications Cymbalta 60 mg oral delayed release capsule Maddox-Martinez,
Kimberly/RN
Home Medications Lyrics 225 mg oral capsule Maddox-Martines,
Iimberly/RN
Home Medications morphine extended release Maddox-Martinez,
Kiraberty/RN
Ifome Medications Patient Currently Takes Medications Maddox-Martincz,
Kimberly/RN
ED Summary Report
JAZ/2012 9:06:27 AM paiif*PIPENT$b 3/2015, PRINTED BY: la3328i4.
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NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021
wey
Palm Bay Hospital Emergency Department MRN;, 000402647 Acct #: HE219400849.
1425 Maiabar Rd, NE 324-434-8015,
Paim Bay, FL 32907 Assessment Sheet Sex: F
Aget 34 DOB: 4/24/1978 Phone: 321-298-0044
‘Name: PHILLIPS, KELLEY ANI
Address: 1700 MANGO ST Ne, PALM BAY, KL 32905
Room Number: PB-R1-PR05-1
Fuk-12-2012 17:09
|Home Medications
|Home Medications Percocet 10/325 oral tablet Maddox-Martinez,
Kimberly/RN
Home Medications phentermine 37.5 mg oral capsule Maddox-Martincz,
Kimberly/RN
MD Referral
Was the pationt referredt the ED by a No. Maddox-Martiaez,
Physician? Kimberly/RN
Primary Assessment
Airway intact Maddox-Martinez,
Kimberly/RN
Breathing No distress. |Maddox-Martinez,
Kimberly/RN
Breathing [Symmetrical chest movement Maddex-Martines,
Kimberly/RN
Breathing Trachea midtine Maddox-Martinez,
Kimberly/RN
Circulation: Adequate Maddox-Martinez,
Kimberly/RN
‘irculation Skin pink Maddox-Martinez,
Kimberly/(RN
Circulation Warm and dey Maddox-Martinez,
Kimberly/RN
Neure jAwakevalert Maddox-Martinez,
Kiraberly/RN
Orientation Oriented x 3 | Maddox-Martiaez,
Kiraberly/RN
Additional Comments Pr C/O generalized malaise including nausea, last | Maddox-Martincez,
lyvornitcd on Monday, headache and abdominal pain, Kimberly/RN
She also stated she has broke out in "cold sweats”.
eulliple tines in the fast 3 days. Denies fever but
did not check ker temp while at home.
Resuscitation Status
Resuscitation Status [Full code por putiont/family Maddox-Martines,
Kimberly/RN
Pain
Pain present? Pain present? Yes Maddox-Martincz,
Kimberly/RN
Abdominal Pain Location Abdomina! Pain epigastric Maddox-Martinez,
H.ocation Kimberly/RN
Pair, Scale Tool Pain Scale Too! 0-10 Maddox-Martiner,
Kimberly(RN
[Abdominal Pain Score Pain Score out of Ten TAO Maddox-Martinez,
Kimberly/RN
ED Summary Report
TAY/2012 9:06:27 AM pai iNFIDENTHSL 3/2015 PRINTED BY: 1a332AQ0 5 of 4
i
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NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021
a
Palm Bay Hospital Emergency Department MRN: HON0402647 Acct #. HI2194N849
4425 Malabar Rd. NIE 321-434-8015,
Palm Bay, FL 32907 A ment Sheet Sex: F
Age: 34 DOB: 4/24/1978 Phone: 321-298-0044
Name: PHILLIPS, KELLEY ANN
Address: 1700 MANGO ST NE, PALM BAY, KL 32905
Room Number: PR-RI-PROS-4
Ful-12-2012 17:09
Pain
Frequency of Abdominal Pain Frequency of Many episodes Maddox-Martinez,
|Abdominal Pain Kiraberly/RN
Abdominal Pain Onset Abdominal Pain Onset Maddox-Martinez,
Kimberly/RN
- Days Maddox-Martinez,
Kimberly/RN
TV Access/Ports/Pumps
Hs FV access’portipamp present? No Maddox-Martinee,
Kimberty/RN
Gi
Glasgow Coma Seale [est motor response: obeys command | Maddox-Martinez,
Kimberly/RN
Glasgow Coma Seale Best verbal response: oriented Maddox-Martines,
Kimberly/RN
Glasgow Coma Scale Eye opening: Spontaneous |Maddox-Martincz,
Kimberly/RN
Glasgow Coma Scare Ww Maddex-Martinez,
Kimberly/RN
Immunizations
Influenza vaccine Date of last influenza vaccine Maddox-Martinez,
Kimberly/RN,
Influenza vaccine (Oct 2011 Maddox-Martincz,
Kimberly/RN
Tetanus Less than 5 years Maddox-Martinez,
Kimberly/RN
|Preumocceal Vaccine INo Maddox-Martiner,
Kimberly/RN
Recent Exposure to Communicable Disease No Maddox-Martinez,
Recent Rxpasure Le Communicable Discasc Kimberly/RN
Communicable Discase History Yes Maddox-Mastinec,
Kimberly/RN
(Communicable Diseases Communicabie (Chickenpox Maddox-Martinez,
Diseases Kimberty/RN
‘Communicable Diseases Communicable Fifth Disease 'Maddox-Martincz,
Discuses Kimberly/RN
Commaunicable Diseases Communicable Vuricella Maddox-Martines,
Diseases Kimberly/RN
Recent Foreign Travel No | Maddox-Martinez,
Kimberly/RN
Social History
‘Tobacco Use Consider Pulmonary Rebab if Never smoker Maddua-Muartines,
tobacco use Kimberly/RN
ED Summary Report
7AM2012 9:06:27 AM pai QhPIDENTI AL 5 2015 PRINTED BY: 1a332QZ2,
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Palm Bay Hospital Emergeacy Departnrent MRN: =Ha0N402647 Acct #. Ht219400849
1423 Malabar Rd. NIE 321-434-8015
Palm Bay, FL 32907 Assessment Sheet Sex: Fr
Age: 34 DOB: 4/24/1978 Phone: 321-298-0044
Name: PHILLIPS, KELLEY ANN.
Address: 1700 MANGO ST NE, FALM BAY, EL 32908
Room Number: PR-EL-PREDS-1
Jul-12-2012 17:09
Social History
Exposure to Second Hand Smoke [Not exposed to second hand smoke Maddox-Martinez,
Kimberly/RN
[Social History
tlistory of Alechol Use No Maddox-Martinez,
Kimberly/RN
History of StroetReercational Drag Use No Maddox-Martines,
Kimberly/RX
Education
Hand Hygiene Practices 2: Meets goals/onicomes Maddox-Martinez,
Kimberly/RN
[Hand Hygiene Practices Demonstration Maddox-Martinez,
Kimberty/RN
Hand Hygiene Practices Patient Maddox-Martinez,
Kimberly/RN:
Hand Hygiene Practices Verbal instruction |Maddox-Martinez,
Kimberly/RN
Hand Hygiene Practices Verhalives understanding
Preview
iD: AR ONX OUN NK 0:40 DV INDEX NO. 21169/2011E NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 EXHIBIT II INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 = Keais mums RECORDS RETRIEVAL IN RE: Kelley Phillips STYLE OF CASE PERTAIN TO Kelley Phillips FROM Palm Bay Hospital (Medical Records) DELIVER TO Yvonne Hyams Havkins Rosenfeld Ritzert & Varriale-59176 114 Old Country Road Suite 300 Mineola, NY 11501 626030 CLIENT MATTER NO. CLAIM NO. 626030-PHNP12040626030-001-BI 11190-305 CASE NO. COURT: Order No. 152247.089 Ui IOAN l= RONX OUN NK 0:40 DV INDEX NO. 21169/2011E NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 & res AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA {This form has been approved by the New York State Department of Heaith] OCA Official Form No. 960 Patient Name Date of Birth ‘Social Security Number KELLEY PHILLIPS _ Patient Address £700 Mango Street NE, Palm Bay FI. 32905 1, o my authorized representative, sequest that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Role of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), [understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENY, except psychotherapy notes, nd CONFIDENTIAL HIV* RELATED INFORMATION only if] place my initials on the appropriate line in Hem 9a), in the event the health information described below includes any of these typcs of information, and 1 initial the line on the box in Hem 9a), I specifically authorize release of such information to the person(s) indicated in tem 8, 2. Uf Lam authorizing the release of HIV-related, elcohol or drug veatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without my authorization untess permitted to do so under federal or staic law. 1 understand that I have the right to request a list of people who may receive or use my HlV-related information without authorization. If J experience discrimination because of the release or disclosure of HIV-related information, 1 may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450, These agencies are responsible for protecting my rights, 3. have the sight to revoke this authorization at any time by waiting to the health care provider listed below. -I understand that I may ravoke this authorization except to the extent that action has already been taken based on this authorization. 4, 1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization ofthis disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2}, and this redisclasuse may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY GR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 {b). 7. Name and address of health provider or entity to release this information: Palm Bay Hospital, 1425 Malabar Road, NE, Palm Bay, FL 32907 8. Name and address of person(s) of category of person to whom this information will be sent: Havkins Rosenfeld Ritzert & Varriale, LLP, 1065 Avenue of the Armericas, Snite 800, New York NY 10018 9(a). Specific information to be released: O Medical Record from (inser date} 10 (insert date} @ Entire Medical Record, including paticnt histories, office notes (except psychotherapy noles), test results, radiology studics, films, referrals, consults, bitling records, insurance records, and records sent to you by other health care providers. C) Other: Include: oo (fadicate by Initaling) AlcoholfDrug Treatment Mental Health Information Authorization (o Discuss Health Information T¥-Related Taformation (&) 0 By initiating here Tauthorize Initials ‘Name of individual health care provider to disouss my health information with my attomey, or a governmental agency, listed here: {Atomey/Firm Name or Gavernmental Agency Name) 10. Reason for rcleasc of information: 11. Date of event on which this authorization will expire: G At request of individual MARIE MORROW Other: Litigation end of litigation ROTARY. 12. {fnot the patient, name of person signing form: 13." Authority to sign on beha of lf WaveHt aqgossat 9 Michael A, Rose Power of Attorney AU it on this form, been compicted and my questions about this form have been answdmedoknras hitdldtipre WoveRaDUF NGG e fh cepy form, ‘Signature of patient or representative authorized by law. out spi * Human anwnedeficieney Virus that causes AIDS. The New Yerk State Public Health Law protects information which reasonably could identify someone as having i37V symptoms or infection and information regarding a persun’s tomiacts, Hs 4a weooi4d] BRON OUN 40 INDEX NO. 21169/2011E NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 Table of Contents Image Page No. 001-ER-7-12-12 002-ER-7-13-12 77 003-A DMIT-9-6-12 137 004-DISCHARGE-SUMMARY 188 005- HISTORY -A ND-PHY SICAL 190 006-PROGRESS-NOTES 191 007-PHY SICIAN-ORDERS 195 008-MEDICATIONS 215 009-VITAILS 237 010-NURSES-NOTES 264 011-ER-4-25-13.... 354 012-ER-7-23-13 394 013-ER-11-20-13 447 014-OP-TESTING-3-19-14 492 015-OP-TESTING-3-25-14 496 016-ER-5-31-14. 499 017-ER-8-2-14 558 018-ER-10-25-14 611 INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021 oe ‘Ex PECTED ADIT DTM | (PATIENT NUMBER: SEX] MAS [RAGE [ADM BY [FIN, CLASS|MEDICAL RECORDS NUMBER "ADMISSION DATE & TE H1219490849 PER - FILS{i LCs £ HCCO402647 07/12/12 1632 PATIENT NAlME AND ADDRESS PATIENT EMPLOYER (aypMeLOYED ‘DISCHARGE DATE & TIME, PHILLIPS, KELLEY ANN UNEMPLOYED O7/12/12 10:05) 1700 MANGO ST NB (221) 298-0044 {H) 321) 298-044 (C) PALM BAY, FL 32805 , FL REGISTRATION ORIGH SERVICE CODE DESCRIPTION INFO. PRIMARY LANGUAGE [LIVING WiLL] PATIENT CLASSIFICATION e PEA EDS EMERGENCY SERVI | YES GLISH NO {i ouirinc PavSIonN 527056 JATTENDING PHYSICIAN 322056 PRIMARY CARE PHYSICIAN FE|AGOSTO DIAZ, EDIL J JAGOSTO DIAZ, BDIL J BEAT, SYED B a. [BIRTHDATE RSE BIRTHPLACE, REGION [CHURCH 34 FL NG INO CHURCH PREFERENCZ 1 [PREVIOUS ADIAISSION NAME, PREVIOUS ADIT DATE [ADMISSION SCURCE [ARRIVAL MODE. PHILLIPS, KELLEY ANN 08/25/12 PED NON HEALTHCARE FAC SELF |GUARANTOR NAME AND ADDRESS: SELF EMPLOYER PHILLIPS, KELLEY ANN KINEMPLOYED 1709 MANGO ST NE (321) 258-0044 | PALM BAY, Fh 32505 ’ PL NEXT OF KIN MOTHER: ADIT TNS DIAGNOSIS. MULTIPLE CCMPLAINTS | PHILLIPS, EILEEN PRIMARY DIAGNCSi < 1790 MAKGO ST NE (221) 789-3523 SECONDARY DIAGNOSIS: a(¢| PALM BAY, FL 32905 CORD# = C0352668 ha PRIMARY SECONDARY S| pout Spit coud GPE cRT: SQLH Facesheet_Cl 2 »FEQO1420 Printed by FormFast at Q7/1Z/2912 2246 DATE 12/23/2015 PRINTED BY: 14332277 ON OUN 0:40 INDEX NO. 21169/2011E NYSCEF BOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 Print Name {Ke jo, KM es, Social Security “aaa fon MAMA lergivt Cxre. Reason for Visit Yes V: Jet Heo] HA [ABD LOCAL DOCTOR Date of Birth Shot Sua A 440005 PEK 7100, BOK, 12/01 DATE 12/23/2015 PRINTED BY: 140332277 l= RONX OUN NK 0:40 DV INDEX NO. 21169/2011E NYSCEF BOC. NO. 246 RECEIVED NYSCEF 10/25/2021 Palm Bay Hospital Emergency Departrient MRN: H000402647 Acct #: HI2194N0R49 1425 Malabar Rd. NE 2 434-8015 Palm Bay, FE. 32907 ment Sheet Sex: F ‘Age: 34 DOB: QB erone: 321-298-0044 Name: PHILLIPS, KELLEY ANN Address: 1700 MANGOST NE, PALM BAY, FL, 32905, Room Number: PR-ETL-PFI ie Complaint: Abdominal pain Nausea Vomiting ‘Acuity: Urgent Arrival Date/Time: 07/12/2012 16:31 Insurance: i Arrived by: Self MD Referral: No PCP: Bhat, Syed Emergency Physician: Agosto Diaz, Edil Accompanied by: No one PA/ARNP: Treatment PTA: Triage Nurse: Past Medical © Primary Language: English Pain Goal: infection Control Alert: Unknown Wei $2.5 kg Tetanus History: Less than 5 years Heigt 167.6 em UMP Date: Presenting Medications Allergies Ar Cay et vi a Ambient 10 mg oral tablet -- 1 orally once a day (at bedtime) gabapentin ~ Gakuown Cymbalta 60 mg oral delayed release capsule ~ 1 orally once a day Other -- Other (at bedtime) tizanidine ~- Syncope; Dizziness Lyrica 225 mg oral capsule -- 1 oraliy 2 times a day trazodone -- Unknown. j5 morphine extended release -- 30 milligram(s) orally every 8 hours fo Percucet 10/325 oral ublet - tab(s) orally 2 times a day as needed phentermine 37.5 mg oral capsule — 1 cap(s) orally once a day Vital DS mn om ee rh wt Butte 12 16-41 97ST 132/94 2 16 100 16:41 07712412 21:19 125/61 60 16 10a 21:19 Disposition Information Primary Diagnosi Abdominal pain - unspecific site ‘Valuable Farm Completed: No Secondary Diagnoss Vomiting ~ adult Family Notification: lReport Catled by: / Report Given Yo: Disposition: Home Discharge Date: 07/12/2012 22:05 IPrescriptions: Ultracet 37,5 mg-325 mg oral tablet, famotidine 20 mg oral cablet, Zofran 4 mg oral tablet ED Summary Report TA3/2012 9:06:27 AM paliRNFIDENTI SL 5 72015 PRINTED BY: LaSS2Rihes 1 of 4 INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021 Palm Bay Hospital Emergency Department MRN: 000402647 Acct ff. H1219400849 1425 Malabar Rd. NE 321-434-8085 Palm Bay, FL 32907 Assessment Sheet Sex: F Age: 34 DOB: 4/24/1978 Phone: 321-298-0044 Name: PHILLIPS, KELLEY ANN Address: 1708 MANGO ST NE, PALM BAY, FL 32905 Room Number: PR-EI-PFOS-1 Orders Laboratory/Blood Bank Orders PHILLIPS, KELLEY ANN - 100040264744 1219400849 ICBC FALZ2012 5:18:08 PM by Agosto Diaz, Edit 7A2/2012 6:33:18 PM CMP 7112/2012 5:18:08 PM by Agosto Diaz, Edil ‘V12/2012 6:46:19 PM HCG Qual 7/12/2012 5:18:08 PM by Agosto Diaz, Edit 7/12/2012 6:59:58 PM Urinalysis 7/12/2012 3:18:08 PM by Agosto Diaz, Edil PA22012 $:41:41 PM Meds and 1Vs Orders PHIT.LIPS, KELT EY ANN - H000402647/H 1219400849 HY DROMOR phone Injectable 71272012 5:18:08 PM by Agosto Diaz, Edil FA2/2012 6:21:06 PM Ondansetron Injectable 7/12/2012 5:18:08 PM by Agosto Diaz, Edit FAQ2032 6:21:07 PM Ondansetron Injectable (232012 8:10:38 PM by Agosto Diaz, Edi) £2/2012 9:34:54 PM Nursing Orders PHILLIPS, KELLEY ANN - 1000402647/H1219400849 Satine Lock ED 7/12/2012 5:18:08 PM by Agosto Diaz, Edil FAB2012 6:21:07 PM (02 ED 7/12/2012 5:18:08 PM by Agosto Diaz, Edil 7412/2012 6:02:11 PM Pulse Ox Continuous ED WIZZ 5:18:08 PM by Agosto Diaz, Edit FA 22012 $:22:29 PM Discharge to Home 7/12i2012 9:34:00 PM by Agosto Diaz, Edi} Not completed al timeof discherge Radiology Orders PHILLIPS, KELLEY ANN - H000402647/H12 19400849 [XR Acute Abdomen Series 7/12/2012 5:18:08 PM by Agosto Diaz, Edil 9412/2012 7:28:11 PM ED Triage Document T2/2012 43, 200 PM To 7/12/2012 4:41:00 PM JSul-12-2012 16:41 Arrival Information ‘Time of Triage 16:42 0 Kelley, Dawn/RN Language Spoken/tindersiood English O Kelley, Dawn/RN Mode Of Arvivat: Self 4) kelley, Dawn/RN ED Summary Report VAZY2012 9:06:27 AM pa QNFIDENTH Sb 3 72015 PRINTED BY: 143322362 2 of 4 INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 Pali Bay Hospital Emergency Department MRN: =HO00402647 Acct i: HI219400849 1425 Malabar Rd. NE 321-434-8015 Palm Bay, FL 32907 Asscesment Sheet Sex: F Age: 34 DOB: 4/24/1978 Phone: 321-298-0044 Name: PHILLIPS, KELLEY ANN Address: 1760 MANGOST NE, #ALM BAY, HL 32905 Room Number: PR-F1-PF05- | Jul-12-2012 16:45 Arrival Information: Means of Arrival [Ambulatory (0 kelley, Dawn/RN [Accompanied by No one O kelley, Dawa/RN Arrival Information Chief Complaint [Abdominal pain 0 kelley, Dawn/RtN Chief Complaint Nausea kelley, DawaiRN Chief Comptaint Vomiting O kelley, Dawn/RN Care Providers Care Providers |Admitting, - EDPHYSICIAN, EDMD O kelley, Dawn/RN Care Providers: |Attending, - EDPHYSICIAN, EDMD_ 0 kelley, DawnRN Care Providers Stated PCP, Bhat, Syed 0 kelley, Dawn/RN | Additional Comments Additional Coraments patient sent from MIMA for further evaluation of =| kelley, Dawn/RN Inausea and vomiting since Monday with abdominal pain, PL also reports breaks out in sweats Tringe Level Triage Level Urgent ‘OD kelley. Dawna/RN: Allergies [Aliergies [gehupentin, Unknown 1 kelley, Dawna/RN [Allergies Other, Other 0 Kelley, DawaiRN Allcrgies rizanidine, Syncope; Dizziness 0 kelley, DawniRN [Atergics trazodone, Unknown 0 kelley, Dawn/RN Height - Weight Weight: Ths Weight: Ths 482 0 kelley, Dawn/RN Weight: kg Weight: kg R23 ky }O kelley, DawaiRN Weight Type Actual ‘0D kelley, Dawa/RN Height: inches of 1 kelley, DawnlRN Height: em 162.6 0 kelley, Dawn/RN Vital Signs; Temperature F 197.5 degrees F 1) kelley, Dawa/RN c 34.3 degrees C 0 kelley, Dawn/RN Fenip Method Temp Method Orat ‘0 kelley, Dawn/RN Heart Rate bpm 72 bpm 1D keltcy, Dawn/RN Systolic Systolic: 132 mm Hie 1 kelley, Dawn/RN ED Summary Report FAYV2O12 9:06:27 AM paki FIPENTY54 3/2015 PRINTED BY: 1u332QQ%. 4 of 14 INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF: 10/25/2021 Palm Bay Hospital Emergency Department. MRN. HO60402647 Acct #: HI219400869 1425 Malabar Rd. NE 321-434-8015 Palm Bay, FL 32907 A ment Sheet Sex: F Age: 34 DOB: A24NSTS Phone: 321-298-0044 Name: PHILLIPS, KELLEY ANN Address: 41700 MANGO ST NE, PALM BAY, BL 32905 Room Ninnher: PR-F1-PF! | Jul-12-2012 16:41 Vital Sigos Diastolic Diastolic 94 mm He 0 kelley, DawnRN Resp Rate /min 16 ‘min }O kelley, Dawa/RN SpO2 Sp02 % 100% O kelley, Dawn/RN Pain [Pain present? Pain present? Yes }O kelley, Dawn/RN- Abdominal Pain Location Abdominal Pain \Epigastric kelley, Dawn/RN Location Pain Scale Tool Pain Scale Too! 0-10 0 Kelley, Dawn/RN | Abdominal Pain Score Pain Score out of ‘len 7 AG O kellcy, Dawn/RN Patient's Pain Goal out of Ten Patient's Pain AO 0 kelicy, Dawn/RN Goal out of Ten Abdominal Pain Oasct Abdominal Pain Onsct 4 0 kelley, Dawn/RN - ays 0 kelley. Dawn/RN Triage Avsessment Ainway intact ‘0 kelley, Dawn/RN Breathing No distress kelley, Dawn/RN Circulation Adequate ‘O kelley, Dawn/RN Neuro Awakevalert D kelley, Dawn/RN Orientation Oriented x 3 0 Kelley, Dawa/RN LMP LMP [iun-21-2012 |e Kelley, DawniRN ED Primary Assessment Document 7/12/2012 4:31:00 PM To 7/12/2012 5:09:00 PME Jul-12-2012 17:09 Home Medications Home Medications Ambien 19 mg oral tablet Maddox-Marlinez, Kimberly/RN Tlome Medications Cymbalta 60 mg oral delayed release capsule Maddox-Martinez, Kimberly/RN Home Medications Lyrics 225 mg oral capsule Maddox-Martines, Iimberly/RN Home Medications morphine extended release Maddox-Martinez, Kiraberty/RN Ifome Medications Patient Currently Takes Medications Maddox-Martincz, Kimberly/RN ED Summary Report JAZ/2012 9:06:27 AM paiif*PIPENT$b 3/2015, PRINTED BY: la3328i4. 4 of 4 INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021 wey Palm Bay Hospital Emergency Department MRN;, 000402647 Acct #: HE219400849. 1425 Maiabar Rd, NE 324-434-8015, Paim Bay, FL 32907 Assessment Sheet Sex: F Aget 34 DOB: 4/24/1978 Phone: 321-298-0044 ‘Name: PHILLIPS, KELLEY ANI Address: 1700 MANGO ST Ne, PALM BAY, KL 32905 Room Number: PB-R1-PR05-1 Fuk-12-2012 17:09 |Home Medications |Home Medications Percocet 10/325 oral tablet Maddox-Martinez, Kimberly/RN Home Medications phentermine 37.5 mg oral capsule Maddox-Martincz, Kimberly/RN MD Referral Was the pationt referredt the ED by a No. Maddox-Martiaez, Physician? Kimberly/RN Primary Assessment Airway intact Maddox-Martinez, Kimberly/RN Breathing No distress. |Maddox-Martinez, Kimberly/RN Breathing [Symmetrical chest movement Maddex-Martines, Kimberly/RN Breathing Trachea midtine Maddox-Martinez, Kimberly/RN Circulation: Adequate Maddox-Martinez, Kimberly/RN ‘irculation Skin pink Maddox-Martinez, Kimberly/(RN Circulation Warm and dey Maddox-Martinez, Kimberly/RN Neure jAwakevalert Maddox-Martinez, Kiraberly/RN Orientation Oriented x 3 | Maddox-Martiaez, Kiraberly/RN Additional Comments Pr C/O generalized malaise including nausea, last | Maddox-Martincez, lyvornitcd on Monday, headache and abdominal pain, Kimberly/RN She also stated she has broke out in "cold sweats”. eulliple tines in the fast 3 days. Denies fever but did not check ker temp while at home. Resuscitation Status Resuscitation Status [Full code por putiont/family Maddox-Martines, Kimberly/RN Pain Pain present? Pain present? Yes Maddox-Martincz, Kimberly/RN Abdominal Pain Location Abdomina! Pain epigastric Maddox-Martinez, H.ocation Kimberly/RN Pair, Scale Tool Pain Scale Too! 0-10 Maddox-Martiner, Kimberly(RN [Abdominal Pain Score Pain Score out of Ten TAO Maddox-Martinez, Kimberly/RN ED Summary Report TAY/2012 9:06:27 AM pai iNFIDENTHSL 3/2015 PRINTED BY: 1a332AQ0 5 of 4 i INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021 a Palm Bay Hospital Emergency Department MRN: HON0402647 Acct #. HI2194N849 4425 Malabar Rd. NIE 321-434-8015, Palm Bay, FL 32907 A ment Sheet Sex: F Age: 34 DOB: 4/24/1978 Phone: 321-298-0044 Name: PHILLIPS, KELLEY ANN Address: 1700 MANGO ST NE, PALM BAY, KL 32905 Room Number: PR-RI-PROS-4 Ful-12-2012 17:09 Pain Frequency of Abdominal Pain Frequency of Many episodes Maddox-Martinez, |Abdominal Pain Kiraberly/RN Abdominal Pain Onset Abdominal Pain Onset Maddox-Martinez, Kimberly/RN - Days Maddox-Martinez, Kimberly/RN TV Access/Ports/Pumps Hs FV access’portipamp present? No Maddox-Martinee, Kimberty/RN Gi Glasgow Coma Seale [est motor response: obeys command | Maddox-Martinez, Kimberly/RN Glasgow Coma Seale Best verbal response: oriented Maddox-Martines, Kimberly/RN Glasgow Coma Scale Eye opening: Spontaneous |Maddox-Martincz, Kimberly/RN Glasgow Coma Scare Ww Maddex-Martinez, Kimberly/RN Immunizations Influenza vaccine Date of last influenza vaccine Maddox-Martinez, Kimberly/RN, Influenza vaccine (Oct 2011 Maddox-Martincz, Kimberly/RN Tetanus Less than 5 years Maddox-Martinez, Kimberly/RN |Preumocceal Vaccine INo Maddox-Martiner, Kimberly/RN Recent Exposure to Communicable Disease No Maddox-Martinez, Recent Rxpasure Le Communicable Discasc Kimberly/RN Communicable Discase History Yes Maddox-Mastinec, Kimberly/RN (Communicable Diseases Communicabie (Chickenpox Maddox-Martinez, Diseases Kimberty/RN ‘Communicable Diseases Communicable Fifth Disease 'Maddox-Martincz, Discuses Kimberly/RN Commaunicable Diseases Communicable Vuricella Maddox-Martines, Diseases Kimberly/RN Recent Foreign Travel No | Maddox-Martinez, Kimberly/RN Social History ‘Tobacco Use Consider Pulmonary Rebab if Never smoker Maddua-Muartines, tobacco use Kimberly/RN ED Summary Report 7AM2012 9:06:27 AM pai QhPIDENTI AL 5 2015 PRINTED BY: 1a332QZ2, 6 of 14 INDEX NO. 21169/2011E NYSCEF DOC. NO. 246 RECEIVED NYSCEF 10/25/2021 Palm Bay Hospital Emergeacy Departnrent MRN: =Ha0N402647 Acct #. Ht219400849 1423 Malabar Rd. NIE 321-434-8015 Palm Bay, FL 32907 Assessment Sheet Sex: Fr Age: 34 DOB: 4/24/1978 Phone: 321-298-0044 Name: PHILLIPS, KELLEY ANN. Address: 1700 MANGO ST NE, FALM BAY, EL 32908 Room Number: PR-EL-PREDS-1 Jul-12-2012 17:09 Social History Exposure to Second Hand Smoke [Not exposed to second hand smoke Maddox-Martinez, Kimberly/RN [Social History tlistory of Alechol Use No Maddox-Martinez, Kimberly/RN History of StroetReercational Drag Use No Maddox-Martines, Kimberly/RX Education Hand Hygiene Practices 2: Meets goals/onicomes Maddox-Martinez, Kimberly/RN [Hand Hygiene Practices Demonstration Maddox-Martinez, Kimberty/RN Hand Hygiene Practices Patient Maddox-Martinez, Kimberly/RN: Hand Hygiene Practices Verbal instruction |Maddox-Martinez, Kimberly/RN Hand Hygiene Practices Verhalives understanding